Collection of Asian Journal of Surgery

The collection is a repository of the open access articles published in the Asian Journal of Surgery journal. Asian Journal of Surgery, launched in 1978, is the official peer-reviewed open access journal of the Asian Surgical Association, the Asia Pacific Metabolic and Bariatric Surgery Society, the Taiwan Robotic Surgical Association, the Taiwan Society of Coloproctology, and the Taiwan Society for Metabolic and Bariatric Surgery. ASJSUR has a growing reputation as an important medium for the dissemination of cutting-edge developments in surgery and its related disciplines in the Asia-Pacific ... show more

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Radiofrequency ablation of varicose veins improves venous clinical severity score despite failure of complete closure of the saphenous vein after 1 year
H. Yong Jin, H. Jin Ohe, J. Kye Hwang, S. Dong Kim, J. Yong Kim, S. Cheol Park, J. Kim, Y. Sung Won, S. Seob Yun, I. Sung Moon

Asian Journal of Surgery (2017). Vol. 40

Abstract
Endovenous treatment is increasingly supplanting open surgery for the treatment of varicose veins. Among emerging endovenous techniques, radiofrequency ablation (RFA) with a ClosureFast catheter is popular in Korea. The objective of this study was to evaluate and compare the efficacy and patient-reported outcomes of RFA of varicose veins. This is a retrospective study of a prospectively registered database of patients who underwent RFA for varicose veins from 2012 to 2013 in St. Marys Hospital in Seoul. Korea. Efficient ClosureFast RFA catheters (Medtronic, San Jose, CA, USA) were used. The techniques used for RFA of varicose veins were performed according to the manufacturers recommendations. Duplex scans and venous clinical severity scores (VCSSs) were used to document treatment outcome and patient symptoms before and after the procedures. Treatment outcomes were estimated before the procedure and 3 months, 6 months, and 12 months after the procedure. Outcomes were analyzed by paired t test, chi-square test, or Fishers exact test as well as by logistical regression. A total of 117 patients were evaluated for 183 consecutive RFA procedures (183 limbs). The initial technical success was 97.3% (178/183). The estimated mean VCSS changed over time from 4.0 ± 1.67 at preprocedure to 0.6 ± 1.05, 0.5 ± 1.02, and 0.6 ± 1.14 at 3 months, 6 months, and 12 months after the procedure, respectively. The improved VCSS was maintained 1 year after the procedure (p < 0.001). Recanalization of the saphenous vein was detected in 20 limbs at the 1-year follow up. The treatment failure group also exhibited a significant decline in the VCSS between preprocedure and 12 months (4.8 ± 1.76 vs. 1.8 ± 2.04, p < 0.001). Specifically, in the treatment failure group, 65% of limbs with episodic recanalization (13/20) were reoccluded or recanalized without venous reflux at the 1-year follow up. In this study, RFA of varicose veins had an initial success rate of 97.7% and a significantly improved patient VCSS at 1 year. Patients with episodic recanalization of the saphenous vein also exhibited an improved VCSS with favorable duplex findings at 1 year.
Abstract
Endovenous treatment is increasingly supplanting open surgery for the treatment of varicose veins. Among emerging endovenous techniques, radiofrequency ablation (RFA) with [...]
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Evolution of video-assisted thoracic surgery (VATS) techniques for Lung cancer; Minimizing surgical injury and Expanding applications
E. Yi, . Dongjin Kim, . Kwhanmien Kim, . Yu-Jen Cheng

Asian Journal of Surgery (2016). Vol. 39
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Recurrence factors and prevention of complications of pediatric differentiated thyroid cancer
. Changyuan Wang, . Xiaohua Chen, X. Wei, F. Chen, Y. Wang, . Zhiyong Shen

Asian Journal of Surgery (2017). Vol. 40

Abstract
To investigate the factors associated with recurrence of differentiated thyroid cancer in children. We combined the clinical and pathological features to guide surgical treatment options, ensure efficacy, and reduce complications. A prospective analysis of clinical data of 43 cases of pediatric differentiated thyroid cancer from March 2008 to June 2014 admitted in our department, including 38 cases of papillary cancers and five cases of follicular cancer, 40 cases were Stage I and three cases were Stage II (Union for International Cancer Control [UICC] Tumor Node Metastasis classification [TNM] staging). We performed the operations according to the condition of lesions and lymph nodes. Operations included subtotal resection in 36 cases, total resection in seven cases. We applied statistical methods to investigate the risk factors of recurrence and postoperative complications. The pathologic lymph node metastasis rate was 67.44% (29/43): Area VI lymph nodes metastases in 20 cases and Area III/IV or Area II/V lymph nodes metastases in nine cases. Postoperative hypocalcemia symptoms were seen in three cases and hoarseness in three cases, for a total rate of 13.95% (6/43). Until December 2015, patients were followed up from 1.5 years to 8.7 years, with a median of 4.9 years. There were three cases of cervical lymph node recurrence, one case of local recurrence, and one case of lung metastasis, for a total recurrence rate of 11.63% (5/43), all patients survived. Log-rank test of Kaplan-Meier curves and Cox stepwise regression analysis showed that lesion number, extrathyroidal extension, and lymph nodes metastases were the risk factors for postoperative recurrence, the relative risk values were, respectively, 3.117, 2.816, and 4.628 (p = 0.041, p = 0.048, and p = 0.031, respectively) and the 95% confidence intervals (CI) were, respectively, 1.094∼8.735, 1.046∼7.932, and 1.189∼10.205. However, the lesion excision approach was not a risk factor for postoperative recurrence (p = 0.107). The logistic stepwise regression model showed that lesion excision approach was a risk factor for postoperative hypocalcemia and hoarseness, the odds ratio value was 2.537 (p = 0.037) and the 95% CI was 1.034∼6.983. Pediatric differentiated thyroid cancer has a high metastatic rate to lymph nodes and distant organs, but the total prognosis is good. Application of total resection cannot necessarily reduce the relapse rate of pediatric differentiated thyroid cancer, but it may increase the postoperative hypocalcemia and hoarseness. The authors propose strictly adhering to various operation indicators, and carrying out various operations with a full understanding of the local lesion and lymph nodes in order to reduce relapse and postoperative complications.
Abstract
To investigate the factors associated with recurrence of differentiated thyroid cancer in children. We combined the clinical and pathological features to guide surgical treatment [...]
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Is the new comer always better?
. Yao-Chou Tsai, S. Chueh, . Shogo Inoue

Asian Journal of Surgery (2016). Vol. 39
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Surgical complications after simultaneous pancreas–kidney transplantation: A single-center experience
M. Khubutia, A. Pinchuk, I. Dmitriev, A. Balkarov, R. Storozhev, Y. Anisimov

Asian Journal of Surgery (2016). Vol. 39

Abstract
We investigated the rate of early surgical complications after simultaneous pancreas–kidney transplantation (SPKT) and their impact on both grafts and recipient survival. The retrospective analysis of typical pancreas-related complications, different methods of correction, and their efficacy were performed. Data describing pancreas transplant recipients were drawn from our SPKT waiting list. The overall surgical complications rate was 37.5%. The 1-year pancreas graft survival was 82.5% and 1-year recipient survival was 90%. Surgical complications based on the graft loss rate did not exceed 2.5%. Direct surgical complications did not account for the loss of a single patient. We conclude that the high rate of surgical complications is a major obstacle to widespread application of pancreas transplantation, early recognition and appropriate treatment of graft-related complications is fundamental for graft survival.
Abstract
We investigated the rate of early surgical complications after simultaneous pancreas–kidney transplantation (SPKT) and their impact on both grafts and recipient survival. [...]
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Donor site morbidity in buccinator-based myomucosal flaps: A retrospective study
. Amin Rahpeyma, . Saeedeh Khajehahmadi

Asian Journal of Surgery (2017). Vol. 40

Abstract
Buccinator-based myomucosal flaps can be used as a lining in oral cavity, pharyngeal, esophageal, and nasal reconstructions. Donor site morbidity is an important factor in selecting a flap, therefore, it was decided that donor site morbidity of this type of flap should be evaluated. In a retrospective study, patients for whom this flap had been used for oral, nasal, or pharyngeal reconstruction in 2008–2012 were recalled. Donor site morbidity including reduction in maximal interincisal opening (MIO), obliteration of the mandibular vestibule, injury to the Stensen duct, and vertical fibrous band in buccal mucosa were evaluated. Twenty-two buccinator-based myomucosal flaps (20 patients) had been used for oral, nasal, or oropharyngeal reconstruction. The most common flap used was the Facial Artery Musculomucosal (FAMM) flap (50%), and the commonest cause for flap use was the presence of a cleft lip/palate sequel in patients (45%). Four patients had developed complications (minimal reduction in MIO) related to the donor site. Donor site morbidity associated with buccinator-based myomucosal flaps is low. However, minimal reduction of mouth opening occurred in 20% of the patients.
Abstract
Buccinator-based myomucosal flaps can be used as a lining in oral cavity, pharyngeal, esophageal, and nasal reconstructions. Donor site morbidity is an important factor in [...]
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Thromboprophylaxis with dabigatran after total hip arthroplasty in Indian patients: A subanalysis of a double-blind, double-dummy, randomized RE-NOVATE II study
. Rajesh Malhotra, . Sushrut Babhulkar, K. Sanjib, . Andreas Clemens, . Akhil Dadi, . Rajagopalan Iyer, . Surendra Kamath, . Bharat Mody, . Satish Mutha, . Gurava Reddy, . Vikram Shah, . Vrajesh Shah, . Naresh Shetty, . Sachin Tapasvi, . Manuj Wadhwa

Asian Journal of Surgery (2017). Vol. 40

Abstract
In the Re-NOVATE II study, oral dabigatran provided thromboprophylaxis after total hip arthroplasty and improved compliance postdischarge in a global population. This article aims to identify trends (if any) in the Indian population. In this prospective, double-blind, double-dummy study, patients scheduled for primary, unilateral, elective total hip arthroplasty were randomized to 220 mg oral dabigatran once daily, starting with a 110 mg half-dose, 1–4 hours after surgery, or subcutaneous enoxaparin 40 mg once daily, starting the evening before surgery. Each group received a placebo of the other study drug. The primary efficacy outcome was the composite of total venous thromboembolism (VTE) and all-cause mortality. Secondary outcome measures were composite of major VTE and VTE-related mortality during the treatment period. The major safety outcome was incidence of bleeding events. Of the 179 Indian patients randomized, 91 received oral dabigatran and 88 received subcutaneous enoxaparin for 28–35 days. Total VTE and all-cause mortality occurred in 18.7% of patients in the dabigatran group and 13.7% in the enoxaparin group [odds ratio = 1.4 (95% confidence interval 0.6, 3.5)]. Major VTE and VTE-related mortality was numerically lower in the dabigatran group (7.9%) compared with the enoxaparin group (9.9%). Safety outcomes were comparable between both groups. Dabigatran is an effective oral alternative to enoxaparin for thromboprophylaxis as demonstrated by the RE-NOVATE II study global results. Data analyzed in Indian patients indicate comparable effects of dabigatran etexilate for major efficacy and safety outcomes.
Abstract
In the Re-NOVATE II study, oral dabigatran provided thromboprophylaxis after total hip arthroplasty and improved compliance postdischarge in a global population. This article [...]
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Factors associated with reoperation in hypospadias surgery — A nationwide, population-based study
. Yu-Chuan Lu, . Wei-Yi Huang, . Yu-Fen Chen, . Hong-Chiang Chang, . Yuan-Hung Pong, . Tsung-Hsien Shih, . Kuo-How Huang

Asian Journal of Surgery (2017).

Abstract
To analyze the preoperative factors associated with the need for secondary surgery following primary urethroplasty. This study utilized a subset of the National Health Insurance Research Database, which includes the data on all paid medical benefit claims from 1997 to 2007, for 1 million beneficiaries in 2005. We analyzed the claims data for all patients with hypospadias who had undergone primary urethroplasty. The characteristics of the patients, surgeons, and hospitals associated with surgical outcomes were analyzed to investigate possible associations with the need for secondary surgery. Among 52, 705 live male newborn babies, 218 were diagnosed with hypospadias, of whom 89 received repair surgery. A total of 75 (84.3%) male newborn babies received single hypospadias surgery, and 14 (15.7%) underwent more than two surgical procedures. Univariate analysis demonstrated that the type of hypospadias and the surgeon caseload volume were significantly associated with the need for additional hypospadias surgery (p = 0.02 and p = 0.03, respectively). In multivariate analysis, the type of hypospadias (distal vs. proximal, odds ratio, 0.25, p = 0.03) and the surgeon caseload volume (high vs. low, odds ratio, 0.04, p = 0.05) were significantly correlated with secondary operation. The type of hypospadias and the surgeon caseload volume were significantly associated with the need for secondary hypospadias surgery. The findings of this study provide important information on the outcomes of hypospadias repair for parents and specialists.
Abstract
To analyze the preoperative factors associated with the need for secondary surgery following primary urethroplasty. This study utilized a subset of the National Health Insurance [...]
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Surgery remains the best option for the management of pain in patients with chronic pancreatitis: A systematic review and meta-analysis
Z. A.R. Jawad, . Charis Kyriakides, . Madhava Pai, . Chris Wadsworth, . David Westaby, . Panagiotis Vlavianos, L. R. Jiao

Asian Journal of Surgery (2017). Vol. 40

Abstract
Controversy related to endoscopic or surgical management of pain in patients with chronic pancreatitis remains. Despite improvement in endoscopic treatments, surgery remains the best option for pain management in these patients.
Abstract
Controversy related to endoscopic or surgical management of pain in patients with chronic pancreatitis remains. Despite improvement in endoscopic treatments, surgery remains [...]
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Management for pilonidal disease: Before you compare, use a classification system
. Oktay Irkörücü, . Zulfu Bayhan, . Sezgin Zeren, S. Duzgun, B. Ucar

Asian Journal of Surgery (2016). Vol. 39
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Perforation of the colon in end colostomy
. Tetsunori Ikegami, . Akira Kuriyama, K. Lyn Ng, W. Kit Cheong

Asian Journal of Surgery (2016). Vol. 39

Abstract
We would like to heartily congratulate the authors Akira Kuriyama and Tetsunori Ikegami for the successful publication of their case report on Perforation of the colon in end colostomy. 1 We read with interest about their experience regarding that of a stercoral perforation occurring proximal to a colostomy in an elderly patient secondary to pressure necrosis from fecal masses. This has enhanced our overall understanding of this rare cause of spontaneous colonic perforation, and we humbly thank them for their citation of our article Surgical pitfalls in patients with Ehlers–Danlos type IV: a case of spontaneous sigmoid perforation in a 17-year-old male.
Abstract
We would like to heartily congratulate the authors Akira Kuriyama and Tetsunori Ikegami for the successful publication of their case report on Perforation of the colon in [...]
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Dexmedetomidine reduces neuropathic pain in a rat model of skin/muscle incision and retraction
. Xizhao Huang, . Rongfang Deng, . Weifeng Tu, . Zurong Hu

Asian Journal of Surgery (2017). Vol. 40

Abstract
Dexmedetomidine has been proposed as a novel anesthetic adjuvant. However, it remains unclear whether peripheral administration of dexmedetomidine is safe and effective to reduce acute postoperative pain. This study aimed to examine the effects of dexmedetomidine on neuropathic pain. Adult male Sprague-Dawley rats were anaesthetized and randomly allocated into four groups (n = 8): Groups S, R, RD1, and RD5 were injected with saline, 0.5% ropivacaine, 0.5% ropivacaine combined with 1 μg dexmedetomidine, and 0.5% ropivacaine combined with 5 μg dexmedetomidine, respectively, around the saphenous nerve. Then, the rats were subjected to skin/muscle incision and retraction (SMIR) surgery in the medial thigh. Mechanical and heat sensitivity was evaluated and morphology of the dorsal root ganglion (DRG) neurons was observed by electron microscopy. Some 62.5%, 50%, 12.5%, and 25% of rats developed mechanical hypersensitivity in Groups S, R, RD1, and RD5, respectively. The number of swollen mitochondria in DRG neurons was significantly more in Group S (257.2 ± 60.9) and Group R (291.6 ± 82.1) than in Group RD1 (97.2 ± 33.3) and Group RD5 (13.6 ± 17.9). In addition, the edema in endoplasmic reticulum and Golgi apparatus was decreased in Group RD1 and Group RD5 compared with Group S and Group R. Peripheral administration of dexmedetomidine improves mechanical and heat hyperalgesia and mitigates postoperative pain.
Abstract
Dexmedetomidine has been proposed as a novel anesthetic adjuvant. However, it remains unclear whether peripheral administration of dexmedetomidine is safe and effective to [...]
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Initial experience with application of single layer modified Kugel mesh for inguinal hernia repair: Case series of 72 consecutive patients
. Pao-Hwa Chen, . Heng-Chieh Chiang, . Yao-Li Chen, . Jesen Lin, . Bai-Fu Wang, . Meng-Yi Yan, . Chun-Chi Chen, . Hung-Jen Shih, . Jian-Ting Chen

Asian Journal of Surgery (2017). Vol. 40

Abstract
This is an initial review of the safety and efficacy of anterior preperitoneal modified Kugel (MK) mesh herniorrhaphy application without using optional onlay mesh. We retrospectively reviewed patients who underwent herniorrhaphy by a single surgeon from July 1st, 2009 to December 31st, 2010. During these 18 months, a total of 72 patients underwent single-layer MK mesh herniorrhaphy. Anterior preperitoneal approach was used to place the mesh. If the patients inguinal hernia defect did not exceed the memory ring of MK mesh, the onlay mesh was omitted. Postoperative results (wound infection, recurrence, and chronic pain/discomfort) were recorded and analyzed. A total of 72 patients underwent anterior preperitoneal single layer MK mesh herniorrhaphy. One patient had recurrent hernia after 1 year and was treated with a laparoscopic transabdominal preperitoneal operation. The most common postoperative complaint was mild soreness which was self-resolving after 1 month. Mean total operative time (skin to skin) was 73 minutes. The average hospital stay was 2 days. Most of the postoperative complications including soreness (14%), pain for > 3 months (1.4%), and scrotal hematoma (1.4%) were self-resolving. One patient experienced wound infection, which was treated with oral antibiotics. One patient had recurrence 1 year after the operation. The postoperative complication and recurrence rates of single-layer MK mesh herniorrhaphy was comparable with previously reported tension-free repair. Single-layer application is safe and feasible. A longer follow-up period and larger study group with a control group are needed to verify our method.
Abstract
This is an initial review of the safety and efficacy of anterior preperitoneal modified Kugel (MK) mesh herniorrhaphy application without using optional onlay mesh. We retrospectively [...]
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Crystallized phenol application and modified Limberg flap procedure in treatment of pilonidal sinus disease: A comparative retrospective study
. Zulfu Bayhan, . Sezgin Zeren, S. Aydin Duzgun, B. Imge Ucar, H. Yumun, . Metin Mestan

Asian Journal of Surgery (2016). Vol. 39

Abstract
Pilonidal sinus treatment includes various surgical and minimally invasive procedures, but there is still no standard treatment. Flap reconstructions and minimally invasive treatment options such as crystallized phenol application have recently been in the center of interest. The aim of this study is to compare crystallized phenol application as a minimally invasive treatment with modified Limberg flap reconstruction from many aspects. Thirty-seven patients diagnosed with pilonidal sinus and treated with modified Limberg flap reconstruction, and 44 patients treated with crystallized phenol application were evaluated retrospectively in terms of age, sex, length of stay in hospital postoperatively, wound complications, and the cause and rate of recurrence. Length of hospital stay was decreased and no postoperative incision problems were found in the group treated with crystallized phenol application (p < 0.001 and p = 0.011, respectively). The difference between the groups in terms of recurrence rate was not statistically significant (p = 0.173). Although the recurrence rate was found to be higher in the patient group treated once with crystallized phenol application, the success rate following multiple applications of crystallized phenol was found to be 94.5%. Higher body mass index (> 24.9 kg/m2) and surgical site infection were strongly correlated with recurrence rate (p < 0.001). Crystallized phenol application is a good alternative to the modified Limberg flap procedure and other surgical procedures, because it has several advantages such as being a minimally invasive procedure performed under local anesthesia with higher success rate after multiple applications, decreased length of stay in hospital, and minimal scar tissue formation.
Abstract
Pilonidal sinus treatment includes various surgical and minimally invasive procedures, but there is still no standard treatment. Flap reconstructions and minimally invasive [...]
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Outcomes of endovascular treatment for TASC C and D aorto-iliac lesions
. Sanghyun Ahn, . Keun-Myoung Park, Y. Kyun Kim, J. Il Kim, I. Sung Moon, K. Chun Hong, Y. Sun Jeon, J. Yong Kim

Asian Journal of Surgery (2017). Vol. 40

Abstract
The aim of this study was to evaluate the technical success rates, primary patency, and complications for TASC C and D aorto-iliac lesions treated by endovascular procedures. Additionally, the influence of the access site and the clinical outcomes were analyzed. Between 2008 and 2014, data from 39 patients with 45 chronic iliac artery stenosis and/or occlusion who were treated with endovascular treatment were retrospectively reviewed. The procedure time was longer for TASC D lesions than for TASC C lesions (163 ± 82 min vs. 105 ± 34 min, p = 0.002), where there was the more common use of brachial and femoral approach simultaneously. There were two perioperative deaths associated with TASC D lesions caused by one iliac artery rupture and one postoperative hospital-acquired pneumonia. The total perioperative complication rate was higher in the TASC D lesions than in TASC C lesions [five (18.5%) vs. zero, p = 0.073]. The corresponding 2-year primary patency rates were 94.9% in TASC C lesions and 88.4% in TASC D lesions. The simultaneous brachial and femoral approach took the longest procedure time (226 ± 157 min). This study demonstrated that the outcomes of endovascular treatment for TASC C and D aorto-iliac lesions were acceptable, with better technical success in TASC C lesions than in TASC D lesions. Furthermore, the 2-year patency rate for both TASC C and TASC D lesions was acceptable. Additionally, brachial access was useful for complex anatomy, but the failure rate was high.
Abstract
The aim of this study was to evaluate the technical success rates, primary patency, and complications for TASC C and D aorto-iliac lesions treated by endovascular procedures. [...]
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Meta-analysis of pancreaticogastrostomy versus pancreaticojejunostomy on occurrences of postoperative pancreatic fistula after pancreaticoduodenectomy
. Yanming Zhou, . Jianhua Yu, L. Wu, B. Li

Asian Journal of Surgery (2015). Vol. 38

Abstract
Pancreatic fistula (PF) is the most common and challenging complication after pancreaticoduodenectomy (PD). This meta-analysis aimed to evaluate the impact of pancreaticogastrostomy (PG) versus pancreaticojejunostomy (PJ) on occurrences of postoperative PF. A systematic literature search in the Medline, EMBASE, OVID, and Cochrane databases was performed to identify all eligible randomized controlled trials (RCTs). Pooled estimates were presented with 95% confidence intervals (CI). Six RCTs involving 1005 patients met the inclusion criteria. The incidence of PF [odds ratio (OR) 0.58, 95% CI, 0.42–0.81, p = 0.001], intra-abdominal abscess or collections (OR 0.43, 95% CI, 0.28–0.65, p < 0.001), and biliary fistula (OR 0.28, 95% CI, 0.11–0.74, p = 0.01) were found to be significantly lower in the PG group than in the PJ group. There was no significant difference in overall morbidity, other complications, hospital mortality, or length of hospital stay between the two groups. The meta-analysis showed that PG following PD represents a safe procedure associated with fewer PFs compared with PJ.
Abstract
Pancreatic fistula (PF) is the most common and challenging complication after pancreaticoduodenectomy (PD). This meta-analysis aimed to evaluate the impact of pancreaticogastrostomy [...]
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Survival after surgical resection of distal cholangiocarcinoma: A systematic review and meta-analysis of prognostic factors
. Yanming Zhou, . Shuncui Liu, L. Wu, T. Wan

Asian Journal of Surgery (2017). Vol. 40

Abstract
This study aimed to assess the available evidence on the survival of distal cholangiocarcinoma (DCC) patients following resection with curative intent and analyze the prognostic factors. Relevant studies published between January 2000 and January 2015 were identified by searching PubMed and Embase and reviewed systematically. Summary relative risks (RR) and 95% confidence intervals (95% CI) were estimated using random-effects models. A total of 39 observational studies involving 3258 patients were included in the review. R0 resection was achieved in 84% (range, 46–100%) of patients. The median 5-year overall survival rate after resection was 37% (range, 13–54%), with corresponding rate of 44% (range, 27–63%) in R0 resection. The meta-analysis for 25 studies showed that R1 resection (RR 2.36, 95% CI 1.89–2.93), lymph node metastasis (RR 2.35, 95% CI 1.89–2.93), perineural invasion (RR 1.96, 95% CI 1.64–2.34), lymphatic invasion (RR 1.84, 95% CI 1.47–2.31), vascular invasion (RR 1.99, 95% CI 1.40–2.82), pancreatic invasion (RR 2.13, 95% CI 1.39–3.27), and pathological tumor stage ≥ T3 (RR 1.56, 95% CI 1.25–1.93) were associated with shorter survival. In general, prognosis of DCC after resection is poor. R0 resection results in a substantially improved survival and represents one of the most important prognostic variables.
Abstract
This study aimed to assess the available evidence on the survival of distal cholangiocarcinoma (DCC) patients following resection with curative intent and analyze the prognostic [...]
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Development and evaluation of a new biodegradable vena cava filter in a canine model
. Fuxian Zhang, . Hailei Li, . Gangzhu Liang, . Huan Zhang

Asian Journal of Surgery (2017). Vol. 40

Abstract
Preliminary testing of a new biodegradable inferior vena cava filter in a canine model. The biodegradable filter consisted of two parts, a filter cone and a stent. The filter cone was constructed of six polyglycolic acid polymer strands anchored to a handmade absorbable stent. Central inferior vena cava fixation was accomplished by the absorbable stent, which was made of polycaprolactone. Device insertion was performed through a 9F sheath under ultrasound guidance on 10 adult beagles. The filters were operatively retrieved at 6 weeks after implantation. The inferior venae cavae were subsequently analyzed grossly and using light microscopy. None of the 10 beagles had abnormal vital signs. All of the 10 filters migrated cephalad approximately
Abstract
Preliminary testing of a new biodegradable inferior vena cava filter in a canine model. The biodegradable filter consisted of two parts, a filter cone and a stent. The filter [...]
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Eyedrop-shaped, modified Limberg transposition flap in the treatment of pilonidal sinus disease
M. Sabuncuoglu, . Aylin Sabuncuoglu, . Ozgur Dandin, M. Benzin, . Girayhan Celik, . Isa Sozen, . Recep Cetin

Asian Journal of Surgery (2015). Vol. 38

Abstract
Pilonidal sinus disease is an inflammatory disease seen in the intergluteal region, which is a commonly encountered problem in surgical practice that mostly affects young people. The aim of this study is to assess the effectiveness of the modified Limberg flap technique with eyedrop excision in the treatment of pilonidal sinus disease. The study population consisted of 91 patients with pilonidal disease in the sacrococcygeal region who underwent operation between June 2010 and December 2012. All cases underwent eyedrop-shaped excision and modified Limberg flap reconstruction. The mean operative time was 41.2 ± 6.7 minutes. All patients were followed up for >8 months, and the mean follow-up period was 13.1 ± 3.7 months. There were three wound dehiscences because of fecal contamination and riding cycle on postoperative Day 5. Seroma and flap echimosis were observed in two and four cases, respectively. Five patients experienced recurrence in this series (4.5%). The results of the present study suggest that use of the eyedrop-shaped modified Limberg flap is associated with a lower maceration and recurrence rate when compared with the available data on the use of the Limberg flap. Flap necrosis and wound healing was better, and the routine use of drains did not affect the wound-related complications and recurrence rates.
Abstract
Pilonidal sinus disease is an inflammatory disease seen in the intergluteal region, which is a commonly encountered problem in surgical practice that mostly affects young [...]
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Predictive factors for longer operative times for thyroidectomy
H. Yong Kwak, . Gianlorenzo Dionigi, . Xiaoli Liu, H. Sun, S. Uk Woo, G. Soo Son, J. Bok Lee, J. Won Bae, H. Yub Kim

Asian Journal of Surgery (2017). Vol. 40

Abstract
Conventional open thyroidectomy is considered as a safe surgery nowadays. However, surgeons sometimes encounter unexpected difficulty when performing thyroidectomies. The aim of this paper was to identify the predictors of a difficult thyroidectomy for the management of patients with papillary thyroid carcinoma. A database of patients who underwent open conventional thyroidectomy with cervical lymph node dissection after diagnosed papillary thyroid carcinoma between July 2008 and June 2013 was examined. In addition, the patients were subgrouped by difficult thyroidectomy (DT) and nondifficult thyroidectomy to determine the predictors of DT according to operation time. Clinicopathologic characteristics, surgical outcomes, and postoperative morbidities were investigated. No between-group differences in clinicopathologic factors and postoperative complications, except for male sex (p < 0.001) and tumor size (p = 0.039), were noted. Male sex [odds ratio (OR) 4.158, 95% confidence interval (CI) 2.020–8.559, p = 0.043] and age < 45 years (OR 2.239, 95% CI 1.304–3.843, p = 0.003) were independent factors associated with DT in a multivariate logistic regression model. Elevated antithyroglobulin antibody (OR 1.004, 95% CI 1.000–1.008, p = 0.030) was a variable which is statistically significant, but not clinically significant. Young age and male sex might be regarded as predictors of DT. Expecting DT before surgery might help surgeons, especially beginners, prevent troublesome situations.
Abstract
Conventional open thyroidectomy is considered as a safe surgery nowadays. However, surgeons sometimes encounter unexpected difficulty when performing thyroidectomies. The [...]
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Comparison between minimal right vertical infra-axillary thoracotomy and standard median sternotomy for repair of atrial septal defects
. Hafize Yaliniz, M. Sah Topcuoglu, . Ugur Gocen, . Atakan Atalay, . Vecih Keklik, . Yuksel Basturk, . Yasemin Gunes, . Mediha Turktan, O. Kemal Salih

Asian Journal of Surgery (2015). Vol. 38

Abstract
The minimal right vertical infra-axillary thoracotomy could be a safe and cosmetic alternative to standard median sternotomy. This study reviews our results and experience with a minimal right vertical infra-axillary thoracotomy technique for the repair of atrial septal defects compared with standard median sternotomy. The study was designed as a retrospective, observational, and case-controlled study. Between May 2007 and November 2012, 26 patients underwent atrial septal defect closure with standard median sternotomy (Group 1). This group was compared with 21 patients who underwent repair of atrial septal defects using minimal right vertical infra-axillary thoracotomy (Group 2). Quantitative data were given as mean ± standard deviation, and qualitative values were expressed as percentages. In the comparison of the normal variables between the two groups, we used independent sample t test, and in the comparison of categorical variables between groups, Chi-square test was used. The mean length of incision was significantly shorter in Group 2 than in Group 1 (p = 0.03). The time it took to establish cardiopulmonary bypass was longer in Group 2 (p = 0.04). There were no statistically significant differences in cardiopulmonary bypass time (p = 0.11), aortic cross-clamp time (p = 0.10), and total operation time (p = 0.10) between the two groups. Group 2 had less chest tube drainage (p = 0.04), less blood transfusion (p = 0.02), and shorter postoperative mechanical ventilation time (p = 0.09) than Group 1. Minimal right vertical infra-axillary thoracotomy can be performed with favorable cosmetic and clinical results for atrial septal defects closure. Infra-axillary thoracotomy provides a good alternative to standard median sternotomy for patients with atrial septal defects.
Abstract
The minimal right vertical infra-axillary thoracotomy could be a safe and cosmetic alternative to standard median sternotomy. This study reviews our results and experience [...]
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Should central lymph node dissection be considered for all papillary thyroid microcarcinoma?
Y. Woo Chang, H. Soo Kim, H. Yub Kim, J. Bok Lee, J. Won Bae, G. Soo Son

Asian Journal of Surgery (2016). Vol. 39

Abstract
Central lymph node dissection (CLND) in patients with papillary thyroid microcarcinoma (PTMC) is still controversial. The aim of this study was to examine the risk factors and the incidence of central lymph node metastases (CLNMs) in patients with PTMC who underwent thyroidectomy and CLND. Between 2002 and 2013, 613 patients were enrolled who underwent thyroidectomy with routine CLND for PTMC at the Korea University Medical Center, Ansan Hospital and risk factors and the incidence of CLNM were analyzed. In addition, we also evaluated the complications after thyroidectomy with CLND. Out of 613 patients, 239 (39.0%) were found to have CLNM. Male sex (p = 0.012), tumor size ≥ 0.5 cm (p = 0.001), capsular invasion or extrathyroidal extension (p = 0.029), and multifocality (p = 0.004) were independent risk factors for CLNM. Among the 69 patients who had PTMC without these risk factors, CLNM was identified in 12 (17.4%). In this study group, two (0.3%) had permanent recurrent laryngeal nerve injury, two (0.3%) had persistent hypocalcemia, and two (0.3%) developed postoperative hemorrhage. CLNM in PTMC is highly prevalent in male sex, tumor size ≥ 0.5 cm, extrathyroidal extension, and multifocality. Even in PTMC patients without these risk factors, the incidence of CLNM is rather higher than expected, and the complication rate of thyroidectomy with CLND is acceptable. Thus, CLND should be considered in all patients with PTMC.
Abstract
Central lymph node dissection (CLND) in patients with papillary thyroid microcarcinoma (PTMC) is still controversial. The aim of this study was to examine the risk factors [...]
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Application of the LMA-Supreme™ and i-gel™ laryngeal masks during pelvic operations in adults
F. Wang, . Rui Zhang

Asian Journal of Surgery (2016). Vol. 39

Abstract
The aim of this study was to evaluate the practical application and safety of the i-gel and LMA-Supreme laryngeal masks for airway management during pelvic operations in adults. Ninety patients undergoing general anesthesia for elective pelvic operations (ASA Grades I-II) were randomly divided into two groups, the i-gel group and the Supreme group. The laryngeal mask was inserted after induction, and the relevant examination grading indexes were recorded. The Supreme group required less time for laryngeal mask insertion and gastric tube indwelling time. Gastric tube indwelling was easier, compared with those in the i-gel group (p = 0.03), but the i-gel group had fewer complications (p = 0.03). There were no significant differences in the degree of difficulty in insertion, airway sealing pressure, PETCO2, Ppeak, and laryngeal mask alignment accuracy between the two groups (p > 0.05). There was no statistically significant difference in fibrobronchoscopy grading between the two groups (p > 0.05). The i-gel and LMA-Supreme laryngeal masks are safe and effective for airway management in patients during pelvic operations.
Abstract
The aim of this study was to evaluate the practical application and safety of the i-gel and LMA-Supreme laryngeal masks for airway management during pelvic operations in adults. [...]
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Short-term results of open inguinal hernia repair with self-gripping Parietex ProGrip mesh in China: A retrospective study of 90 cases
. Yinlong Wang, . Xin Zhang

Asian Journal of Surgery (2016). Vol. 39

Abstract
This study investigated short-term outcomes of Lichtenstein hernia repair using self-gripping Parietex ProGrip mesh in Chinese patients with inguinal hernias. Retrospective analysis of patients undergoing Lichtenstein hernia repair using the Parietex ProGrip mesh at a single hospital in China between July 2012 and June 2013. All patients completed the EuroQol-five dimensions (EuroQoL-5D) and short form-36 questionnaires and were followed up at 1 day, 7 days, 1 month. and 6 months, postoperatively. Ninety cases (66 males, 24 females) were studied. Mean ± standard deviation (SD) patient age was 48.7 ± 16.8 (range, 21–87) years. Most hernias were Gilberts type II (23%) or III (31%). During 6 months of follow-up, none of the patients had recurrent hernia or systemic postoperative complications. The mean ± SD pain visual analog scale score decreased from 32 ± 10.6 at postoperative Day 1 to 0.67 ± 2.5 at 6 months. From postoperative Day 1 to 6 months, there were marked improvements in health and health-related quality of life, mean ± SD visual analog scale EuroQoL score increased from 55.3 ± 8 to 95.2 ± 3 and mean ± SD HR EuroQoL score from 0.31 ± 0.07 to 0.95 ± 0.02. At 6 months, mean scores in all eight dimensions of the short form-36 questionnaires had increased from baseline. The use of self-fixating Parietex ProGrip mesh in open inguinal hernia repair is simple, rapid, effective, and safe, and is associated with low postoperative pain and improved quality life among patients.
Abstract
This study investigated short-term outcomes of Lichtenstein hernia repair using self-gripping Parietex ProGrip mesh in Chinese patients with inguinal hernias. Retrospective [...]
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Safety of clean urologic operations without prophylaxis antibiotic therapy in Cipto Mangunkusumo Hospital, Jakarta: A double-blind randomized controlled trial study
. Irfan Wahyudi, . Ponco Birowo, I. Gde Sanjaya, . Rizky Fawzi, . Nur Rasyid, C. A. Mochtar

Asian Journal of Surgery (2015). Vol. 38

Abstract
This study was conducted to identify the safety measures of performing clean urologic operations without administration of prophylaxis antibiotics. We conducted a double-blind randomized controlled trial with patients who underwent clean urologic operations in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from April 2013 to January 2014. The local and systemic infection states were compared between the prophylaxis and placebo groups. Local infection was identified as surgical site infection and systemic infection as fever and leukocytosis. A total of 42 patients participated in the study (21 patients in each group), comprising 14 (33.3%) children and 28 (66.7%) adults. The most frequently performed operation was surgical sperm retrieval. No patients in either group were found to have local or systemic infection. However, there was a statistical difference in the white blood cell counts between the two groups (p = 0.003), although there was no sign of local or systemic infection in any of the patients. Clean urologic operations without prophylaxis antibiotic therapy can be safely applied to urologic patients.
Abstract
This study was conducted to identify the safety measures of performing clean urologic operations without administration of prophylaxis antibiotics. We conducted a double-blind [...]
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Bilateral idiopathic granulomatous mastitis
. Mehmet Velidedeoglu, . Fahrettin Kilic, . Birgul Mete, . Mucahit Yemisen, . Varol Celik, . Ertugrul Gazioglu, . Mehmet Ferahman, . Resat Ozaras, M. Yilmaz, . Fatih Aydogan

Asian Journal of Surgery (2016). Vol. 39

Abstract
Idiopathic granulomatous mastitis (IGM) is a benign rare inflammatory pseudotumor. Bilateral involvement of IGM has been reported in a few cases. To our knowledge, this study is the largest series of bilateral cases to date. The goals of this study were to present clinical features of bilateral IGM and to evaluate the results of treatments. We performed a retrospective review of the idiopathic granulomatous mastitis database from 2010 to 2013. Ten female patients who met required histologic and clinical criteria of IGM in both breasts were included in study. Demographic data, clinical findings, medication history, and radiologic findings are presented. The mean age at onset of the disease was 38.4 ± 8.3 years (range: 29–52 years). Nine patients had no recurrence during a mean follow-up period of 21 months (range: 11–26 months). Additionally, the median time to second breast involvement was 15.6 months. Bilateral IGMs have a higher rate of more relapse and greater resistance to medical therapies than do unilateral IGMs. Surgical management should be avoided unless all medical treatment options have been exhausted. Nevertheless, expectant management seems a rational option for the treatment of bilateral IGM.
Abstract
Idiopathic granulomatous mastitis (IGM) is a benign rare inflammatory pseudotumor. Bilateral involvement of IGM has been reported in a few cases. To our knowledge, this study [...]
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The learning curve for laparoscopic colectomy in colorectal cancer at a new regional hospital
. Kuei-Yen Tsai, . Kee-Thai Kiu, . Ming-Te Huang, . Chih-Hsiung Wu, . Tung-Cheng Chang

Asian Journal of Surgery (2016). Vol. 39

Abstract
Laparoscopic colorectal surgery has been extensively used, although mostly performed in medical centers or university hospitals. We analyzed the learning curve of laparoscopic colectomy in a new regional hospital and determined the experience necessary to achieve proficiency. From July 2008 to December 2013, the retrospective clinical study enrolled 240 patients who underwent laparoscopic colectomy. They were sequentially divided into Group A (Patients 1–80), Group B (Patients 81–160), and Group C (Patients 161–240). Patient demographics and perioperative parameters were analyzed. Operation time, as a measure of learning time, was analyzed using the moving-average method. All patients were comparable for age, gender, body mass index, tumor location, cancer stage, length of hospital stay, intraoperative complication, morbidity, and mortality. Group A experienced more blood loss (p < 0.01) and longer operation time (p < 0.001). All laparoscopic operation time stabilized after 85 cases. Subgroup analysis showed that operation time stabilized after 15 cases for right hemicolectomy, 15 cases for sigmoidectomy, and 22 cases for low anterior resection with total mesorectal excision. Laparoscopic colectomy for colorectal cancer in a new regional hospital is feasible and safe. It does not need additional time for learning. Laparoscopic sigmoidectomy can be considered as the initial surgery for a trainee.
Abstract
Laparoscopic colorectal surgery has been extensively used, although mostly performed in medical centers or university hospitals. We analyzed the learning curve of laparoscopic [...]
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Analysis of risk factors of long-term complications in congenital diaphragmatic hernia: A single institutions experience
. Hajime Takayasu, . Kouji Masumoto, . Takahiro Jimbo, . Naoya Sakamoto, . Takato Sasaki, . Toru Uesugi, . Chikashi Gotoh, . Yasuhisa Urita, . Toko Shinkai

Asian Journal of Surgery (2017). Vol. 40

Abstract
To establish better management practices to reduce morbidities in survivors with congenital diaphragmatic hernia (CDH). Of 60 patients treated for CDH at our institution between 1991 and 2011, 49 patients without severe anomalies were retrospectively reviewed. Since 2004, gentle ventilation (GV) has been the main treatment for CDH. Patients were divided into the following two groups: the non-GV group (n = 29) who were treated before GV treatment was implemented, and the GV group (n = 20). The overall survival rate was 62.1% (18/29) and 95% (19/20) in the non-GV and GV groups, respectively (p = 0.016). Despite the high survival rate, the incidence of long-term complications in survivors was still high (14/19, 73.7%) in the GV group. In the GV group, liver-up (p = 0.106) and the need for patch repair (p = 0.257) tended to be associated with the development of long-term complications, but did not reach statistical significance. The presence of perioperative complications was associated with the development of long-term complications (p = 0.045) in the GV group. Patients who developed short-term complications seemed to be at risk of long-term complications. Therefore, to minimize long-term morbidities in CDH survivors, the prevention of short-term complications might be important.
Abstract
To establish better management practices to reduce morbidities in survivors with congenital diaphragmatic hernia (CDH). Of 60 patients treated for CDH at our institution between [...]
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A case of rare primary cystic-type squamous cell carcinoma of the breast that could be preoperatively diagnosed
. Keiichi Takahashi, . Tomoko Wakasa, . Masayuki Shintaku

Asian Journal of Surgery (2017). Vol. 40

Abstract
Primary squamous cell carcinoma of the breast (SCCB) is a rare disease, with a worldwide incidence
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The incidence and outcome of allied disorders of Hirschsprungs disease in Japan: Results from a nationwide survey
. Tomoaki Taguchi, . Satoshi Ieiri, . Kina Miyoshi, . Kenichi Kohashi, . Yoshinao Oda, . Akio Kubota, . Yoshio Watanabe, . Hiroshi Matsufuji, . Masahiro Fukuzawa, . Takeshi Tomomasa

Asian Journal of Surgery (2017). Vol. 40

Abstract
Allied disorders of Hirschsprungs disease (ADHD) have been proposed to be the concept of the functional obstruction of the intestine with the presence of ganglion cells in the terminal rectum. They are classified into two categories based on pathology: (1) abnormal ganglia, including immaturity of ganglia, hypoganglionosis (HG), and intestinal neuronal dysplasia, (2) normal ganglia, including megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS), segmental dilatation (SD), internal anal sphincter achalasia (IASA), and chronic idiopathic intestinal pseudo-obstruction (CIIP). Some of these show poor prognosis, therefore, the establishment of criteria and appropriate treatment strategies is required. The questionnaires were sent to the 161 major institutes of pediatric surgery or gastroenterology in Japan, in order to collect the cases of ADHD during 10 years from 2001 and 2010. In total, 355 cases were collected. They included 28 immaturity of ganglia, 130 HG (121 congenital, 9 acquired), 18 intestinal neuronal dysplasia, 33 MMIHS, 43 SD, three IASA, and 100 CIIP. Of the 95 institutes, 69 (72.6%) had their own criteria for ADHD. Criteria were based on clinical symptoms and signs, and conventional pathological examinations. Prognosis was poor in congenital HG, MMIHS, and CIIP, while the others showed good survival rates. Almost all Japanese cases of ADHD in the past 10 years were collected. Congenital HG and CIIP showed relatively high incidence, whereas acquired HG and IASA were extremely rare in Japan. The criteria of each disorder were also collected and summarized. Prognosis was poor in congenital HG, MMIHS, and CIIP.
Abstract
Allied disorders of Hirschsprungs disease (ADHD) have been proposed to be the concept of the functional obstruction of the intestine with the presence of ganglion cells in [...]
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Eight cases of salvage pulmonary resection for residual disease or isolated local recurrence detected after definitive chemoradiotherapy for N2 Stage-IIIA lung cancer
. Shigeki Sawada, . Hiroshi Suehisa, . Tsuyoshi Ueno, . Motohiro Yamashita

Asian Journal of Surgery (2017). Vol. 40

Abstract
The concept of salvage pulmonary resection after definitive chemoradiotherapy (dCRT) is not yet commonly accepted in lung cancer treatment. We report our experience of eight patients in whom we performed salvage pulmonary resection for residual disease or isolated locoregional recurrence detected after dCRT. Between 2005 and 2014, we performed salvage pulmonary resection for eight patients with N2 Stage-IIIA non-small cell lung cancer. The patients had initially received dCRT (radiation ≤ 60 Gy), but eventually underwent pulmonary resection with curative intent for residual disease or isolated locoregional recurrence. The postoperative complications, incidence of recurrence, and survival parameters were evaluated. Salvage pulmonary resection was performed in four patients with residual disease and four patients with locoregional recurrence. Complete resection was successfully performed in all eight patients. Postoperative complications were observed in three patients, however, there were no postoperative mortalities. One patient developed local recurrence in a mediastinal lymph node and two patients died. Of the two fatalities, one was related to lung cancer. The estimated 5-year survival rate of the eight patients was 75.0%. We report our experience of salvage pulmonary resection performed for residual disease or isolated locoregional recurrence diagnosed after dCRT in eight patients with locally advanced lung cancer. Although the postoperative complication rate was high, the survival data were favorable. A larger study is needed to confirm the safety and feasibility of salvage pulmonary resection after dCRT.
Abstract
The concept of salvage pulmonary resection after definitive chemoradiotherapy (dCRT) is not yet commonly accepted in lung cancer treatment. We report our experience of eight [...]
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Premaxillary osteotomy fixation in bilateral cleft lip/palate: Introducing a new technique
. Amin Rahpeyma, . Saeedeh Khajehahmadi, . Ali Ghasemi

Asian Journal of Surgery (2016). Vol. 39

Abstract
In bilateral cleft lip/palate patients, sometimes the premaxilla is severely protruded and twisted. In such situations premaxillary osteotomy is beneficial. In this article a new technique for fixation of premaxilla after osteotomy is presented. The lip-split approach and premaxillary osteotomy and ostectomy from bony nasal septum were carried out. Fixation of osteotomized premaxilla was achieved with low profile miniplate or microplate. Bone grafting of that side was performed during the same session. This procedure was performed in three patients, with good labial repair after the lip split. The bone graft was successful in all the three cases and there were no complication for premaxillary osteotomy in this series. In protruding premaxilla, osteotomy and fixation of premaxilla with miniplate to the vomer bone during alveolar bone grafting through a lip-split approach yielded satisfactory results in patients requiring secondary functional cheilorhinoplasty.
Abstract
In bilateral cleft lip/palate patients, sometimes the premaxilla is severely protruded and twisted. In such situations premaxillary osteotomy is beneficial. In this article [...]
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Laparoscopic sleeve gastrectomy in Asia: Long term outcome and revisional surgery
. Eng-Hong Pok, . Wei-Jei Lee, . Kong-Han Ser, . Jung-Chien Chen, . Shu-Chun Chen, . Ju-Juin Tsou, . Kin-Fah Chin

Asian Journal of Surgery (2016). Vol. 39

Abstract
Laparoscopic sleeve gastrectomy (LSG) is a popular stand-alone bariatric surgery, despite a paucity of long-term data. Hence, this study is to report the long-term outcome of LSG as primary bariatric procedure and the result of revisional surgery. With retrospective analysis of a prospective bariatric database, participants who defaulted clinic follow-up were interviewed by telephone. A total of 667 LSG was performed as primary bariatric procedure (2006–2012) with mean age of 34.5 ± 9.7 years old, female 74.7%, mean body mass index (BMI) 37.3 ± 8.1 kg/m2. A 36-F bougie was used for all cases. There were 61 patients available with long-term data. The weight loss outcome at 1 year, 2 years, 3 years, 4 years, and 5 years showed a mean BMI 26.3, 25.2, 25.3, 27.1, and 26.2 with mean excess weight loss (EWL) 76.0%, 79.6%, 77.3%, 73.4%, and 72.6% respectively. However, 17% patients developed de novo gastro-esophageal reflux disease (GERD). Eighteen patients (2.2%) needed surgical revisions due to weight regain (n = 6), persistent type 2 diabetes mellitus (T2DM, n = 2), stricture (n = 2), and GERD (n = 8). The revision resulted in an additional mean excess weight loss of 23.8% with mean BMI 24.9 kg/m2 at 6 months postoperatively. There was a 23.7% mean reduction of HbA1c with one patient who was in complete diabetic remission at 1 year. Our results showed LSG is a durable bariatric procedure with > 70% EWL at 5 years despite a high incidence of GERD. The need for revision of LSG is low and mainly for GERD.
Abstract
Laparoscopic sleeve gastrectomy (LSG) is a popular stand-alone bariatric surgery, despite a paucity of long-term data. Hence, this study is to report the long-term outcome [...]
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Cholecystitis after yttrium-90 resin microsphere radioembolization treatment: Clinical and pathologic findings
. Sagun Parakh, . Sivakumar Gananadha, . Robert Allen, . Desmond Yip

Asian Journal of Surgery (2016). Vol. 39

Abstract
Radioembolization with yttrium microspheres is an established therapeutic modality for primary and secondary hepatic malignancies, with studies demonstrating improved overall survival. There remains a paucity of data on cholecystitis as a complication of radioembolization. We describe a small series of patients who developed cholecystitis as a result of radioembolization. Patients who had developed cholecystitis as a complication of radioembolization in our institution between 2001 and 2012 were retrospectively reviewed. Patient demographics, cancer details including treatment history, and procedural details of radioembolization and complications of cholecystitis were collected. Of 74 patients who underwent radioembolization using yttrium-90emitting microspheres, four (5.4%) presented with acute cholecystitis as a result of their treatment. All patients presented over 4 weeks following radioembolization and did not settle with conservative treatment. At surgery, the gallbladder was fibrotic and contracted in all cases making surgery difficult. The incidence of symptomatic radiation cholecystitis after radioembolization is low, and prophylactic cholecystectomy is not routinely recommended for patients undergoing radioembolization. Radiation cholecystitis should be suspected in patients presenting with symptoms of biliary colic or cholecystitis following radioembolization. Early cholecystectomy can be considered in patients undergoing surgery for other indications, especially in high-risk surgical patients in whom there is a high likelihood of radioembolization in the future as they do not respond to conservative treatment.
Abstract
Radioembolization with yttrium microspheres is an established therapeutic modality for primary and secondary hepatic malignancies, with studies demonstrating improved overall [...]
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Laparoscopic surgery in functional and nonfunctional adrenal tumors: A single-center experience
. Bahadır Öz, . Alper Akcan, . Ertan Emek, . Muhammet Akyüz, . Erdogan Sözüer, . Hızır Akyıldız, . Adnan Bayram, . Rıdvan Kulu, E. Ok

Asian Journal of Surgery (2016). Vol. 39

Abstract
Laparoscopic adrenalectomy (LA) is a safe and minimally invasive operation for benign adrenal tumours. The purpose of this study was a retrospective analysis of outcomes following laparoscopic lateral transabdominal adrenalectomy performed for benign adrenal tumours responsible for various endocrinological disorders and non-functioning tumours. A total of 100 laparoscopic adrenalectomy were carried out between January 2007 and March 2013 via the lateral transabdominal approach. The analysed factors included demographic data of patients, indication for surgery, tumour size and side, intraoperative and postoperative outcome of laparoscopic lateral transabdominal adrenalectomy including duration of surgery, length of hospital stay, the complication rate, as well as the conversion rate to open adrenalectomy. There were 34 patients with non-functioning tumours (Group 1) and 66 with functioning tumours (Group 2). The intraoperative and postoperative outcomes were not significantly different in the cases among the analysed groups of patients. The median operative time was 101 ± 4.3 (range, 30–210) minute in group 1 and 95 ± 5.9 (range, 30–190) minute in group 2, there was not statistically significant (p = 0.56). The median duration of the postoperative hospital stay in the group 1 was bigger than group 2, this did not differ significantly (p = 0.08). Peroperative complications were occured in 9 (9%) patients, observing 6 (9%) patients in Group 1 and 3 (8.8%) patients in Group 2. There was not statistically significant (p = 0.96). In the postoperative period, three patients in group I, 1 patient in group II developed complications, this difference was not statistically significant (p = 0.69). The conversion to open surgery was found in 9 (9%) patients. This study shows that laparoscopic lateral transabdominal adrenalectomy is a safe, effective, and technically feasible procedure in the treatment of both functioning and nonfunctioning benign tumours of the adrenal gland.
Abstract
Laparoscopic adrenalectomy (LA) is a safe and minimally invasive operation for benign adrenal tumours. The purpose of this study was a retrospective analysis of outcomes following [...]
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A comparison of surgical outcome of fasciocutaneous V–Y advancement flap and Limberg transposition flap for recurrent sacrococcygeal pilonidal sinus disease
. Bahadır Öz, . Alper Akcan, E. Emek, . Muhammed Akyüz, . Erdogan Sözüer, . Hızır Akyldız, . Hüsnü Aydın

Asian Journal of Surgery (2017). Vol. 40

Abstract
The aim of this study was to compare the surgical outcome of fasciocutaneous V–Y advancement flap and limberg transposition flap used to treat recurrent sacrococcygeal PSD. A total of 58 patients with recurrent pilonidal sinus who underwent surgery were evaluated retrospectively between January 2008 to December 2013. Fasciocutaneous V–Y advancement flap was performed in 25 patients (Group VYF), and limberg transposition flap repair was performed in 33 patients (Group LTF). Patient demographics, operative and postoperative outcomes were recorded then retrospectively analyzed. The mean age (p = 0.69), sex ratio (p = 0.48), and concomitant diseases (p = 0.98) were not statistically different when compared the VYF with LTF groups. Mean operative time was 55 ± 19 min for the LTF group and 75 ± 25 min for the VYF group (p = 0.01). When length of hospital stay were compared, there was a significant difference between the groups (p = 0.01). Return to work was carryed out after a mean of 23 ± 1.1 days in VYF group and 16.7 ± 1.2 days in LTF group, which is significantly different (p < 0.0004). Between the groups, there was no significantly different regarding surgical complication and recurrent rate. Only one recurrence (4%) was found in VYF group. Limberg transposition flap may be use in recurrent cases of PSD, because of the lower recurrence rate and less hospital stay time, early return to work. Most important advantage of fasciocutaneous V–Y advancement flap is the ability to close larger defects in recurrent cases.
Abstract
The aim of this study was to compare the surgical outcome of fasciocutaneous V–Y advancement flap and limberg transposition flap used to treat recurrent sacrococcygeal PSD. [...]
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Is surgical plication necessary in diaphragm eventration?
. Serdar Özkan, . Ülkü Yazici, . Ertan Aydin, . Nurettin Karaoğlanoğlu

Asian Journal of Surgery (2016). Vol. 39

Abstract
Diaphragm plication surgery is conducted to remove dyspnea, which results from mediastinal shift, atelectasia, and ventilation/perfusion dyssynchrony in lungs that occur because of an eventrated diaphragm. This study aims to determine whether diaphragm plication has any effect on respiration by analyzing the patients' changing values in the respiratory function test (RFT) after plication surgery. Sixteen patients who underwent diaphragm plication surgery in our clinic because of plication eventration or paralysis were examined prospectively. Diaphragm eventration values were assessed using a calculation method that uses posteroanterior pulmonary radiographies taken during patient admission and control, then, these data were recorded. The amount of changes in the eventration levels and in restrictive respiratory failure parameters—forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) of RFTs—conducted in pre- and postoperative control periods were compared using statistical analysis methods. The compatibility between the amounts of RFT changes was examined through a satisfaction survey—using a questionnaire that consisted of multiple choice questions with answer options such as “better, ” “the same, ” and “worse”—to understand preoperative and postoperative symptom levels in the 12th month of postoperative control. According to postoperative levels, a decrease between 19% and 23% was observed in eventration amounts within the 1st postoperative month, 6th postoperative month, and 12th postoperative month. In addition, the highest average increase in FEV1 liter (lt) values was 0.2 lt and 0.25 in FVC (lt) values. Researchers of this study believe that more distinctive decisions need to be taken while identifying patients for surgery in unilateral diaphragm eventrations, especially in the adult patient group, surgical option should be used for cases in which the eventrated diaphragm results in mediastinal shift and respiratory failure.
Abstract
Diaphragm plication surgery is conducted to remove dyspnea, which results from mediastinal shift, atelectasia, and ventilation/perfusion dyssynchrony in lungs that occur because [...]
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Technique and outcome of autotransplanting thyroid tissue after total thyroidectomy for simple multinodular goiters
A. A. Mohsen, A. A. Nada, M. Y. Ibrahim, A. H. Ghaleb, M. Abou-Gabal, A. A. Mohsen, A. T. Wassef

Asian Journal of Surgery (2017).

Abstract
Limited animal and human studies have shown function, albeit inadequate, of implanted thyroid tissue in muscles. This work aimed to ascertain results in a larger number of patients, finding practical method for implantation, studying the effect of changing weight of implant and effect of passage of time on its function. Forty patients had total thyroidectomy for simple multinodular goiters. A piece of the excised gland was finely minced, mixed with saline as emulsion, and injected in thigh muscles. Twelve patients had 5-g implants, while 28 patients had 10-g implants. Four parameters were studied at 2 months, 6 months, and 12 months: technetium isotope uptake by the implant, thyroid stimulating hormone (TSH), free T3 (FT3), and free T4 (FT4). All autotransplanted thyroid tissue survived and functioned. After 12 months, mean values (± standard deviation) of isotope uptake, TSH, FT3, and FT4 of the 5-g implants were 0.44 ± 0.16%, 27.74 ± 30.4 UI/mL, 3.07 ± 1.10 pg/mL, and 1.01 ± 0.3 ng/dL, repectively. Those for the 10 g implants were 0.71 ± 0.20%, 22.78 ± 19.7 UI/mL, 3.92 ± 1.2 pg/mL, and 1.05 ± 0.3 ng/dL, repectively. Ten-gram implants showed significantly higher isotope uptake than 5-g. TSH, FT3, and FT4 significantly improved over the period of 1 year. Injection of thyroid tissue suspension is a simple method for thyroid autotransplantation. TSH was elevated in the majority to maintain normal or near normal thyroid hormones. Ten-gram implants showed higher isotope uptake than 5-g, although this difference was not reflected by thyroid hormone profile. The implant seemed to function better with the passage of time from 2 months to 12 months.
Abstract
Limited animal and human studies have shown function, albeit inadequate, of implanted thyroid tissue in muscles. This work aimed to ascertain results in a larger number of [...]
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The role of prophylactic cefazolin in the prevention of infection after various types of abdominal wall hernia repair with mesh
M. Bahar, A. Nooghabi, M. Nooghabi, . Ali Jangjoo

Asian Journal of Surgery (2015). Vol. 38

Abstract
There are controversies about the benefits of prophylactic antibiotics in the prevention of postoperative surgical site infection (SSI) in mesh herniorrhaphy for a long time. This study aimed to evaluate the effectiveness and efficacy of systemic prophylactic cefazolin in prevention of wound infection in various types of hernia repair with mesh materials. This is a prospective randomized control study. We evaluated wound infection rates in 395 patients with various kinds of hernia who underwent elective mesh repair using polypropylene mesh from 2007 to 2011. A total of 237 (60.0%) patients received prophylactic cefazolin (study group) and the remaining 158 (40.0%) patients did not receive any prophylactic antibiotics (control group). Patients were followed for infection at the following periods after the operation by an independent surgeon: 10 days, 30 days, 12 months, and then annually for at least 2 years. Eight (2.03%) patients had infection in the site of surgery [2 (1.27%) in the control group and 6 (2.53%) in the study group]. The distribution of infection was not significantly different between the two groups (p = 0.364). The superficial infections were managed by drainage and irrigation. One patient from the study group developed deep SSI and was readmitted and subsequently received antibiotic therapy, drainage, and debridement. Preoperative administration of single-dose cefazolin for prosthetic hernia repairs did not markedly decrease the risk of wound infection. Our results do not support the use of cefazolin as a prophylactic antibiotic for various kinds of abdominal wall hernia repair with mesh.
Abstract
There are controversies about the benefits of prophylactic antibiotics in the prevention of postoperative surgical site infection (SSI) in mesh herniorrhaphy for a long time. [...]
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Application of intraoperative magnetic resonance imaging in large invasive pituitary adenoma surgery
J. Li, . Zixiang Cong, . Xueman Ji, . Xiaoliang Wang, . Zhigang Hu, Y. Jia, . Handong Wang

Asian Journal of Surgery (2015). Vol. 38

Abstract
To investigate the clinical application value of intraoperative magnetic resonance imaging (iMRI) in large invasive pituitary adenoma surgery. A total of 30 patients with large pituitary adenoma underwent microscopic tumor resection under the assistance of an iMRI system, 26 cases received surgery through the nasal–transsphenoidal approach, and the remaining four cases received surgery through the pterion approach. iMRI was performed one or two times depending on the need of the surgeon. If a residual tumor was found, further resection was conducted under iMRI guidance. iMRI revealed residual tumors in 12 cases, among which nine cases received further resection. Of these nine cases, iMRI rescanning confirmed complete resection in six cases, and subtotal resection in the remaining three. Overall, 24 cases of tumor were totally resected, and six cases were subtotally resected. The total resection rate of tumors increased from 60% to 80%. iMRI can effectively determine the resection extent of pituitary adenomas. In addition, it provides an objective basis for real-time judgment of surgical outcome, subsequently improving surgical accuracy and safety, and increasing the total tumor resection rate.
Abstract
To investigate the clinical application value of intraoperative magnetic resonance imaging (iMRI) in large invasive pituitary adenoma surgery. A total of 30 patients with [...]
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Bariatric versus diabetes surgery after five years of follow up
. Wei-Jei Lee, . Abdullah Almulaifi, . Keong Chong, . Wei-Cheng Yao, J. Juin Tsou, . Kong-Han Ser, . Yi-Chih Lee, . Shu-Chun Chen, . Jung-Chien Chen

Asian Journal of Surgery (2016). Vol. 39

Abstract
Bariatric surgery (BS) is totally different from diabetes surgery (DS) in the patient characters, goals of surgery, and management although similar in surgical procedure. Comparison of BS and DS with long-term data is lacking. A retrospective review of patients who received BS and patients who received DS at Min-Sheng General Hospital from 2007 to 2013 was designed. All inpatient and outpatient follow-up data were analyzed. Patients undergoing BS for the treatment of morbid obesity were compared with patients undergoing metabolic surgery for the treatment of type 2 diabetes mellitus (T2DM). Patients who received revision surgeries were excluded. The main outcome measures were: (1) operation risk, (2) weight loss, and (3) diabetes remission. Between 2007 and 2013, 2073 patients who received BS and 741 patients who received DS were recruited from both centers. DS patients were older (41.1 ± 10.9 years vs. 33.1 ± 9.3 years, p < 0.05) and were more likely to be male (40.2% vs. 28.2%, p < 0.05) and to have diabetes (100% vs. 6.0%, p < 0.05), however, they had similar body mass index (BMI) (37.9 ± 8.0 vs. 38.5 ± 9.7, p = 0.78) compared to the BS patients. Surgical procedures are significantly different between the two groups (73.3% of the DS surgeries were gastric bypass procedure, whereas this procedure made up only 47.1% of BS surgeries). Although the major complication rates were similar (2.0% vs. 2.4%), the DS program had a significant higher mortality rate than the BS program (0.54% vs. 0.1%, p < 0.05). At the 5-year follow-up time point, 58.0% of the BS patients had achieved successful results (weight loss > 30%) and 80% of the DS patients had complete remission of their diabetes [hemoglobin A1c (HbA1c) < 6.0%]. Both the DS and the BS group had good results in up to 85% of the patients at the 5-year follow-up time point. The clinical profiles were very different between the BS and the DS programs. Both programs achieved the desired outcomes equally well, however, the DS program had a higher risk than the BS program.
Abstract
Bariatric surgery (BS) is totally different from diabetes surgery (DS) in the patient characters, goals of surgery, and management although similar in surgical procedure. [...]
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Outcome and risk factor analysis of patients who underwent open infrarenal aortic aneurysm repair
Y. Law, Y. Che Chan, G. C.Y. Cheung, A. Ting, S. Cheng

Asian Journal of Surgery (2016). Vol. 39

Abstract
The aim of this study was to evaluate the short- and long-term outcomes in patients who underwent open infrarenal aortic aneurysm repair. Consecutive patients who underwent open repair of infrarenal aortic aneurysms at our institution from July 1st 1990 to June 30th 2012 were reviewed from a prospective collected departmental database. Short-term outcomes included 30-day mortality and peri-operative complications. Independent risk factors to predict 30-day mortality were identified. Long-term survival and secondary interventions were also reported. Three hundred and eighty-three patients (317 males, median age 72 years with a range of 15–90 years) underwent open infrarenal aortic aneurysm repair during the period, of whom 266 (69.5%) were elective, 18 (4.7%) were urgent for symptomatic but nonruptured cases, and 99 (25.8%) were emergency procedures for ruptured aneurysms. Mean aneurysm size was 6.5 cm (ranging from 2.5 cm to15 cm). All patients were followed up for at least 24 months with a mean follow up period 163 months. Overall 30-day mortality was 11.0% (36.4% for ruptured cases, 11.1% for symptomatic cases, and 1.5% for elective cases, p < 0.001). Preexisting renal disease and ruptured aneurysms were independent risk factors for 30-day mortality (p = 0.001 and p = 0.006 respectively). Systemic complications included 50 cardiac events, 52 respiratory events, six renal events, three cerebral vascular accidents, and one deep vein thrombosis/pulmonary embolism. Local complications included two anastomotic/graft hemorrhage, 10 distal thrombosis/embolisms, five bowel ischemias, one spinal cord ischemia, and 17 wound complications. The ruptured group presented survival rates of 53.5%, 50.5%, 47.5%, 42.3%, 38.0%, 21.9%, and 12.5% at 1 year, 2 years, 3 years, 4 years, 5 years, 10 years, and 15 years, respectively, while nonruptured survival rates were 91.5%, 88.0%, 83.7%, 78.3%, 73.0%, 43.0%, and 25.3%, respectively (log rank p < 0.001). For those who died 30 days after the operation, only six patients (1.8%) died from aneurysm related mortality. A total of three (0.9%) patients underwent late re-interventions, one for late aorto-enteric fistulae and two for anastomotic pseudoaneurysms. In the current era of endovascular repair, open infrarenal aneurysm repair is effective and durable, and has very low secondary interventions rates.
Abstract
The aim of this study was to evaluate the short- and long-term outcomes in patients who underwent open infrarenal aortic aneurysm repair. Consecutive patients who underwent [...]
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Robot-assisted laparoscopic hepaticojejunostomy for advanced malignant biliary obstruction
E. C.H. Lai, C. Ngai Tang

Asian Journal of Surgery (2015). Vol. 38

Abstract
To report our experience in palliative hepaticojejunostomy for advanced malignant biliary obstruction by means of robotic approach Robot-assisted laparoscopic hepaticojejunostomy for advanced malignant biliary obstruction was performed in nine patients from May 2009 to April 2014. During the study period, robotic hepaticojejunostomy for advanced malignant biliary obstruction was completed successfully in nine patients. Roux-en-Y hepaticojejunostomy and double (hepaticojejunostomy, and gastrojejunostomy) bypass were performed in five and four patients, respectively. The mean operating time was 212.8 minutes. The mean blood loss was 38.7 mL. The overall complication rate was 22.2%. Bile leak complication occurred in one patient only. There was no procedure-related mortality. The mean postoperative hospital stay was 13.3 days. Five patients received palliative systemic chemotherapy after bypass surgery. The mean survival time was 11.1 months. During follow up, only three patients with cholangiocarcinoma had recurrent biliary obstruction after end-to-side hepaticojejunostomy due to tumor progression, and needed percutaneous transhepatic biliary drainage. Among these nine patients, there were a total of eight episodes of readmission in four patients due to tumor-related symptoms or complications. Robot-assisted laparoscopic hepaticojejunostomy for advanced malignant biliary obstruction had a low complication rate and was associated with an improved quality of life.
Abstract
To report our experience in palliative hepaticojejunostomy for advanced malignant biliary obstruction by means of robotic approach Robot-assisted laparoscopic hepaticojejunostomy [...]
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Prognosis of papillary thyroid cancers with positive serum thyroglobulin antibody after total thyroidectomy
. Sheng-Fong Kuo, . Tzu-Chieh Chao, . Hung-Yu Chang, . Chuen Hsueh, . Chih-Lang Lin, . Kun-Chun Chiang, . Wen-Yu Chuang, . Yung-Chih Chen, . Jen-Der Lin

Asian Journal of Surgery (2017). Vol. 40

Abstract
To investigate the influence of serum anti-thyroglobulin antibody (TgAb) on the prognosis in papillary thyroid cancer (PTC) patients. In this retrospective study, the participants were enrolled from 1206 PTC patients (927 women, 279 men, mean age, 42.2 years) with T2 and higher, or N1 or M1 classifications in tumor–node–metastasis staging after total thyroidectomy. We recorded the final serum TgAb data (on thyroxin therapy) at the end of follow-up in 2012. Patients were classified as negative TgAb or positive TgAb groups on the basis of their serum TgAb levels (< 70 IU/mL or ≥ 70 IU/mL). Among the 1206 patients, after mean follow-up for 11.6 ± 6.1 years (range, 2.0–29.2 years), there were 75 with positive TgAb and 1131 with negative TgAb. Patient categorization depending on the follow-up time (2–5 years after surgery, 5–10 years after surgery, and 10–30 years after surgery) was performed. In comparison to traditional risk factors, such as age, tumor size, and sex, which were important prognostic factors for cancer recurrence and mortality in PTC patients, there was no significant difference in the prognosis between positive TgAb patients and negative TgAb patients by the multivariate analyses (cancer recurrence, p = 0.164, p = 0.112, p = 0.202, respectively, cancer mortality, p = 0.181, p = 0.646, p = 0.656, respectively) based on the different follow-up times. Positive serum TgAb was not a risk factor, and was not associated with the prognosis of PTC patients.
Abstract
To investigate the influence of serum anti-thyroglobulin antibody (TgAb) on the prognosis in papillary thyroid cancer (PTC) patients. In this retrospective study, the participants [...]
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Colo-colonic anastomosis in a continuous-flow left ventricular assist device patient
W. J. Knaus, C. H. Olson

Asian Journal of Surgery (2017). Vol. 40

Abstract
Noncardiac operations are being increasingly performed on patients with left ventricular assist devices (LVADs). However, little is known on the impact of continuous-flow LVADs on the vascular supply of the colon for anastomoses. In this case, a 67-year-old male supported on an LVAD underwent four successful noncardiac operations including two intestinal anastomoses, left colon and small bowel anastomosis. To the best of our knowledge, no existing literature has reported successful colonic anastomosis on a continuous-flow LVAD. This case illustrates the plausibility of performing colonic anastomoses with appropriately selected patients supported on an LVAD. A 67-year-old male with congestive heart failure underwent LVAD placement for decompensated heart failure while awaiting orthotopic transplantation. During his recovery, he developed a stage IV sacral decubitus ulcer which required a sigmoid loop colostomy placement and a rotational flap. Subsequent stoma closure with partial sigmoid colectomy and stapled anastomosis was performed, and healed without evidence of anastomotic leak. This case illustrates the potential for colonic anastomoses for patients on continuous-flow LVAD support. Although oxygenation is known to be an important aspect of healing, this patients outcome suggests that intestinal anastomoses can be performed on the induced pulseless environment of an LVAD. Further studies will be needed to further elucidate the success of longer segment resections and appropriate surgical candidates.
Abstract
Noncardiac operations are being increasingly performed on patients with left ventricular assist devices (LVADs). However, little is known on the impact of continuous-flow [...]
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Internal hernia after laparoscopic gastrectomy with Roux-en-Y reconstruction for gastric cancer
. Hideyo Kimura, . Mikimasa Ishikawa, . Toshinaga Nabae, . Taketo Matsunaga, . Soichiro Murakami, . Masahiko Kawamoto, . Tetsuro Kamimura, . Akihiko Uchiyama

Asian Journal of Surgery (2017). Vol. 40

Abstract
Laparoscopic gastrectomy (LG) is increasingly used to treat gastric cancer. Simultaneously, internal hernia (IH) has been reported after LG with Roux-en-Y reconstruction (RY). The aim of this study was to investigate IH after LG with RY for gastric cancer. This study included 15 patients with IH from a database of 355 consecutive patients who underwent LG with RY for gastric cancers. We retrospectively analyzed IH incidence and clinical characteristics by operative procedures. The total incidence of IH was 4.2%. The incidence of IH at Petersens defect tended to decrease with modifications to the reconstruction methods, but not significantly so. The incidence of IH at jejunojejunostomy mesenteric defect significantly decreased with closure of this defect (p = 0.01). The incidence of IH at transverse mesocolic defect was 1.3% in patients who underwent retrocolic RY, emergent small-bowel resection was only required in two cases of herniation through this defect after laparoscopic total gastrectomy. Retrocolic RY with appropriate closure of defects can reduce IH incidence at Petersens defect and at jejunojejunostomy mesenteric defect. Although the IH incidence at the transverse mesocolic defect is not particularly high, the possibility of herniation through this defect should be kept in mind.
Abstract
Laparoscopic gastrectomy (LG) is increasingly used to treat gastric cancer. Simultaneously, internal hernia (IH) has been reported after LG with Roux-en-Y reconstruction (RY). [...]
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Simultaneous resection of pulmonary tumor following cardiovascular surgery
. Ryosuke Kaku, . Koji Teramoto, . Keiko Ishida, . Tomoyuki Igarashi, . Masayuki Hashimoto, . Shoji Kitamura, . Noriaki Tezuka, . Tohru Asai, . Jun Hanaoka

Asian Journal of Surgery (2017). Vol. 40

Abstract
A pulmonary tumor is occasionally detected on a chest computed tomography (CT) scan before cardiovascular surgery. In this study, we examined clinical courses of patients who had undergone the simultaneous resection of a pulmonary tumor following cardiovascular surgery. From 2008 to 2013, 18 patients (13 men and 5 women) with a median age of 69.8 years underwent the wedge pulmonary resection for a lung tumor through a median thoracotomy following cardiovascular surgery in our hospital. Cardiovascular surgeries consisted of off-pump coronary artery bypass grafting (CABG) in six patients, aortic valve replacement and/or mitral valve plasty in 10 patients, total arch replacement in 10 patients and descending aorta replacement in 10 patients. No complications associated with pulmonary resections were observed. Pathological examination revealed that 15 patients (83.3%) were diagnosed with lung cancers including 13 adenocarcinomas and two squamous cell carcinomas, with the clinical stages of 1A in 13 patients, 2A in one patient and 2B in one patient. Among them, five patients received the radical pulmonary resection subsequently, whereas 10 patients were unable to receive it due to their poor cardiopulmonary function. Kaplan-Meier analysis of patients with lung cancer revealed that the 5-year survival rate and progression-free survival (PFS) rate after 3 years from the surgery were 46.2% and 73.8%, respectively. The simultaneous resection of pulmonary tumor following cardiovascular surgery is safely performed, and is useful for the pathological diagnosis of the tumor. Further studies are warranted, however, this procedure may contribute to controlling the progression of lung cancer in patients with cardiovascular disease with comorbidities.
Abstract
A pulmonary tumor is occasionally detected on a chest computed tomography (CT) scan before cardiovascular surgery. In this study, we examined clinical courses of patients [...]
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Microsurgery in 46 cases with total hand degloving injury
J. Ju, . Jianning Li, . Ruixing Hou

Asian Journal of Surgery (2015). Vol. 38

Abstract
To summarize the characteristics of total hand degloving injury and investigate the curative effect of microsurgery. A total of 46 patients with total hand degloving injury were enrolled in this study. The injury classification and treatment methods were as follows: Type I (11 cases), treated by replantation of the gloved skin, Type II (6 cases), treated by reconstruction using thumb wrap-around flap and second toe, Type III (4 cases), treated by reconstruction using bilateral second toe with dorsal foot flap, Type IV (9 cases), treated by replantation in situ or reconstruction, Type V (16 cases), treated by replantation or abdominal flap reconstruction. Of the patients who received Type I treatment, five completely survived, whereas eight had finger necrosis. In Type II, both the reconstructed fingers and hand flaps survived. For four patients who received Type III treatment, eight reconstructed fingers survived. In Type IV, two patients with reconstructed fingers survived, whereas the six with replantation in situ had necrosis of the partial palmar or hand dorsum skin. In Type V, nine patients with reconstructed fingers survived, and five cases with abdominal skin flap reconstruction and one case with anterolateral femoral flap survived. The restoration of hand appearance and function was the best in patients who received replantation. For reconstruction cases, however, the hand function was recovered to the basic self-care level. In cases with abdominal flap reconstruction, the hand function showed poor recovery. Total hand degloving injury can be classified into different types according to the injury degree. The appropriate microsurgical treatment based on these types can produce better curative effect.
Abstract
To summarize the characteristics of total hand degloving injury and investigate the curative effect of microsurgery. A total of 46 patients with total hand degloving injury [...]
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Comparative outcomes of lateral transperitoneal adrenalectomy versus posterior retroperitoneoscopic adrenalectomy in consecutive patients: A single surgeons experience
Y. Jun Chai, . Jung-Woo Woo, . Hyungju Kwon, J. Young Choi, . Su-jin Kim, K. Eun Lee

Asian Journal of Surgery (2016). Vol. 39

Abstract
Among several minimally invasive adrenalectomy techniques, lateral transperitoneal adrenalectomy (LTA) is the procedure of choice for benign adrenal tumors, however, posterior retroperitoneoscopic adrenalectomy (PRA) is an alternative that is increasing in popularity. This study compared the outcomes of these two approaches. Since a single surgeon started adrenalectomy, LTA had been performed exclusively until PRA was adopted and became the standard treatment. Therefore, the consecutive patients were allocated into two groups according to the date of surgery: the first group received LTA and the second group received PRA. LTA was performed in 29 patients and PRA in 19 patients. There was no difference in sex, age, body mass index, clinical diagnosis, and tumor size between the LTA and the PRA group. The PRA group showed less blood loss (117.0 mL vs. 58.5 mL, p = 0.035) and tended to have a shorter operating time (92.2 minutes vs. 78.1 minutes, p = 0.054) and less pain score on postoperative Day 1 (3.8 vs. 3.0, p = 0.095) and Day 2 (3.2 vs. 2.5, p = 0.051). The mean operation time was significantly shorter for patients in the PRA group undergoing right adrenalectomy (109.2 minutes vs. 80.5 minutes, p = 0.009), but those undergoing left adrenalectomy had a similar operating time to the LTA group (83.2 minutes vs. 74.8 minutes, p = 0.380). PRA is a good alternative operative technique for an endocrine surgeon who is experienced in the transperitoneal approach.
Abstract
Among several minimally invasive adrenalectomy techniques, lateral transperitoneal adrenalectomy (LTA) is the procedure of choice for benign adrenal tumors, however, posterior [...]
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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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Meningeal seeding from glioblastoma multiforme treated with radiotherapy and temozolomide
. Lu-Ting Kuo, . Shao-Yu Tsai, . Chung-Yi Yang, . Long-Wei Lin

Asian Journal of Surgery (2017). Vol. 40

Abstract
Extracranial and meningeal seeding of glioblastoma multiforme is rare. We report herein a case of glioblastoma in a 41-year-old man who underwent surgical resection, concomitant chemoradiotherapy (CCRT) and seven courses of adjuvant chemotherapy with temozolomide. The patient then complained of intermittent severe lower back pain and gait disturbance. Imaging studies demonstrated that although the intracranial residual tumors were well-controlled by the treatment, meningeal seeding involving the brainstem and spinal cord was present. The patient died 2 months after the diagnosis of spinal seeding. This case illustrates the need for consideration of extracranial metastasis if a patient is symptomatic, even if the intracranial tumor appears responsive to treatment. We suggested that the prophylactic craniospinal irradiation may be considered in patients at high risk of meningeal seeding immediately after surgery.
Abstract
Extracranial and meningeal seeding of glioblastoma multiforme is rare. We report herein a case of glioblastoma in a 41-year-old man who underwent surgical resection, concomitant [...]
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Results of laparoscopic colorectal surgery from a national training center
R. Maitra, A. G. Acheson, . Chris Gornall, J. H. Scholefield, J. P. Williams, C. Maxwell-Armstrong

Asian Journal of Surgery (2014).

Abstract
Trials have shown laparoscopic colorectal surgery to be safe. We aim to analyze the long-term results from a single national training center for laparoscopic surgery, especially in patients with high predicted mortality scores as well as in octogenarians. We also aim to explore the trend in the length of the learning curve among consultants and colorectal trainees, and determine whether or not laparoscopic colorectal surgery is amenable to surgical training. All patients between July 2003 and July 2011 having laparoscopic colorectal surgery were included in a prospectively maintained database and analyzed retrospectively. We collected operative data (operation time, conversion), postoperative 30-day morbidity/mortality, cancer survival (including local/distant recurrences), postoperative incisional/port site hernia rates, and rates of reoperation. A total of 508 patients (258 males and 250 females) were enrolled in the study. The mean age of patients was 65.5 years and median body mass index (BMI) 27 kg/m2, 70% of cases were malignant. Conversion rate was 15%, mean operation time was 175 minutes, and mean blood loss was 220 mL. The mean postoperative length of stay was 5.8 days, 30-day morbidity 23% (leak rate 1.38%), and 30-day mortality 1.57%. Operating time and conversion rates were significantly lower in right-sided resections compared to left-sided and rectal resections, and lymph node retrieval was significantly higher. Readmission and reoperation rates were 4.9% and 2.8%, respectively. The overall mean follow-up period was 1.8 years, rate of incisional/port site/parastomal hernia was 5.7% (n = 30), and readmission secondary to adhesions was 5% (P-Possum tool). No statistically significant increases were observed in conversion, morbidity, or mortality rates in these groups (p > 0.05), but length of stay was statistically longer—7 days for octogenarians and 8 days for patients with >5% predicted mortality (p < 0.05). In 2003, two consultants operated on all cases, currently, twice as many procedures are performed by supervised trainees instead of consultants, with no change in outcome. Operating time was significantly higher in the consultant-led cases, but no other differences were noted in short- or long-term outcomes between consultant- and junior/senior trainee-led cases. We conclude that laparoscopic colorectal surgery should be the standard treatment option offered to all patients regardless of age and comorbidities and it is amenable to training.
Abstract
Trials have shown laparoscopic colorectal surgery to be safe. We aim to analyze the long-term results from a single national training center for laparoscopic surgery, especially [...]
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Light-chain amyloidosis presenting with rapidly progressive submucosal hemorrhage of the stomach
. Song-Yi Kim, . Suk-Bae Moon, S. Koo Lee, S. Kweon Hong, Y. Hee Kim, G. Bong Chae, . Sung-Bae Park

Asian Journal of Surgery (2016). Vol. 39

Abstract
The gastrointestinal tract is frequently in involved light-chain (AL) amyloidosis, but significant hemorrhagic complications are rare. A 71-year-old man presented to our hospital with dyspepsia and heartburn for 1 month. Gastroscopy revealed a large submucosal hematoma at the gastric fundus. Two days later, a follow-up gastroscopy indicated extensive expansion of the hematoma throughout the upper half of the stomach. The hematoma displayed ongoing expansion during the endoscopic examination, suggesting that rupture was imminent. Emergency total gastrectomy was performed, and amyloidosis was confirmed after examining the surgical specimen. Bone marrow examination revealed multiple myeloma, and serum immunoglobulin assay confirmed the diagnosis of myeloma-associated AL amyloidosis. At manuscript submission, the patient was doing well and was undergoing chemotherapy.
Abstract
The gastrointestinal tract is frequently in involved light-chain (AL) amyloidosis, but significant hemorrhagic complications are rare. A 71-year-old man presented to our hospital [...]
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Adventitial cystic disease of the common femoral vein presenting as deep vein thrombosis
. Young-Kyun Kim, H. Jong Chun, J. Kye Hwang, J. Il Kim, S. Dong Kim, . Sun-Cheol Park, I. Sung Moon

Asian Journal of Surgery (2016). Vol. 39

Abstract
Adventitial cystic disease of the common femoral vein is a rare condition. We herein report the case of a 50-year-old woman who presented with painless swelling in her left lower leg that resembled deep vein thrombosis. She underwent femoral exploration and excision of the cystic wall. The presentation, investigation, treatment, and pathology of this condition are discussed with a literature review.
Abstract
Adventitial cystic disease of the common femoral vein is a rare condition. We herein report the case of a 50-year-old woman who presented with painless swelling in her left [...]
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Incretin levels 1 month after laparoscopic single anastomosis gastric bypass surgery in non-morbid obese type 2 diabetes patients
M. Jin Kim, H. Kyu Park, D. Won Byun, K. Il Suh, K. Yul Hur

Asian Journal of Surgery (2014). Vol. 37

Abstract
Bariatric surgery is an efficient procedure for the remission of type 2 diabetes (T2DM) from morbid obesity. However, in Asian countries, the mean body mass index (BMI) of T2DM patients is about 25 kg/m2. Various data on patients undergoing gastric bypass surgery suggest that the control of T2DM after surgery occurs rapidly. We hypothesized that even in nonobese patients with T2DM, the levels of incretin and insulin changed along with the improvement of T2DM as a consequence of the gastric bypass. From March to December 2011, 12 nonobese patients (mean BMI, 26.2 kg/m2) with poorly-controlled [mean glycated hemoglobin (HbA1C), 9.5%] diabetes underwent gastric bypass surgery. Values related to diabetes, including incretin [gastric inhibitory peptide (GIP) and glucagon-like peptide-1 (GLP-1)] levels were measured before and 1 month after surgery. All values were measured in response to a 75 g oral glucose tolerance test (OGTT). On average, the BMI decreased by 2.1 ± 0.7 kg/m2. Mean HbA1C level decreased by 1.6 ± 2%. Oral glucose-stimulated insulin levels increased and GLP-1 levels also increased significantly. Oral glucose-stimulated GIP levels decreased sharply. Soon after gastric bypass in nonobese T2DM patients, control of T2DM is achieved. The incretin release after oral glucose is improved. This could be a consequence of changes of the enteroinsular axis, particularly in the incretins.
Abstract
Bariatric surgery is an efficient procedure for the remission of type 2 diabetes (T2DM) from morbid obesity. However, in Asian countries, the mean body mass index (BMI) of [...]
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Carcinoid tumors of the lung: A report of 11 cases
. Yoshinobu Ichiki, . Akira Nagashima, . Manabu Yasuda, . Mitsuhiro Takenoyama

Asian Journal of Surgery (2013). Vol. 36

Abstract
Carcinoid tumors of the lung are rare, and account for 1% of all primary tumors of the lung. This study was undertaken to investigate the histological characteristics and clinical behavior of carcinoid tumors of the lung. We have retrospectively reviewed the hospital records of 11 consecutive patients undergoing surgical treatment for carcinoid tumors of the lung between 1992 and 2007. Patients with carcinoid tumors accounted for 0.8% (11 of 1319) of the patients undergoing surgical treatment for nonsmall cell lung cancer. The group comprised six males and five females with a mean age at presentation of 58.6 years (range 27–78 years). All of the operations were lobectomies, including two sleeve lobectomies. Six patients had typical and five had atypical carcinoid tumors. Seven patients had stage IA disease, two had stage IB, one had stage IIA, and one had stage IIIA. Recurrent tumors developed in two of the five patients affected by atypical carcinoid tumors, but none of the six patients with typical carcinoid tumors. Overall, the 5-year survival rate of patients with both typical and atypical carcinoid tumors was 90.9%. Survival of carcinoid tumors was favorable. In this analysis, two patients with atypical carcinoid had postoperative recurrences. Recurrence was more common among patients with atypical carcinoid tumors.
Abstract
Carcinoid tumors of the lung are rare, and account for 1% of all primary tumors of the lung. This study was undertaken to investigate the histological characteristics and [...]
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Surgical treatment of catamenial pneumothorax: Report of three cases
. Yoshinobu Ichiki, . Akira Nagashima, . Manabu Yasuda, . Mitsuhiro Takenoyama, . Satoshi Toyoshima

Asian Journal of Surgery (2015). Vol. 38

Abstract
Catamenial pneumothorax (CP) is a rare entity of spontaneous, recurring pneumothorax in females. Although it has been known to be associated with thoracic endometriosis, varying clinical course and the lack of consistent intraoperative findings have led to conflicting etiological theories. We herein discuss the etiology, clinical course, and surgical treatment of three patients with CP. Three females (aged 40 years, 28 years, and 34 years) had recurrent right-sided spontaneous pneumothoraces that coincided with their menses. They had undergone video-assisted thoracoscopic surgery (VATS) previously. Blueberry spots in the right diaphragm were detected in all three cases. Two patients had recurrence, postoperatively. The other patient, who received luteinizing hormone-releasing hormone analog therapy for an abdominal endometriosis in the perioperative period and postoperative chemical pleurodesis to prevent recurrence, has been free of recurrence for 15 months, postoperatively. However, pelvic endometriosis was detected in this patient only. Therefore, CP should be suspected in ovulating females with spontaneous pneumothorax, even in the absence of any symptoms associated with pelvic endometriosis. In addition, while performing VATS, careful inspection of the diaphragmatic surface is important. In complicated cases, hormonal suppression therapy and chemical pleurodesis might also be helpful adjunct modalities.
Abstract
Catamenial pneumothorax (CP) is a rare entity of spontaneous, recurring pneumothorax in females. Although it has been known to be associated with thoracic endometriosis, varying [...]
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Pseudoaneurysm after sutureless repair of left ventricular free wall rupture: Sequential magnetic resonance imaging demonstration
. Yung-Kun Hsieh, . Chien-Hui Lee, . Yih-Sharng Chen, I. Wu

Asian Journal of Surgery (2015). Vol. 38

Abstract
Sutureless repair is an effective procedure for acute left ventricular free wall rupture, however, it may be complicated with a left ventricular pseudoaneurysm during the late postoperative period. We present a case of a large ventricular pseudoaneurysm that occurred after the sutureless repair of an inferior myocardial infarction with oozing left ventricular free wall rupture. The patient underwent aneurysmectomy successfully. Serial magnetic resonance imaging (MRI) indicated that the necrotic left ventricular wall, which was covered by Teflon felt, had ruptured and developed a pseudoaneurysm. Therefore, after simple gluing for a left ventricular free wall rupture, patients should undergo careful follow-up evaluation for potential pseudoaneurysm. Moreover, early detection by MRI and prompt surgical repair of the complication are important in patients with left ventricular free wall rupture.
Abstract
Sutureless repair is an effective procedure for acute left ventricular free wall rupture, however, it may be complicated with a left ventricular pseudoaneurysm during the [...]
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Anastomotic stability and wound healing of colorectal anastomoses sealed and sutured with a collagen fleece in a rat peritonitis model
. Christoph Holmer, . Christiane Praechter, . Lars Mecklenburg, . Markus Heimesaat, . Hayo Rieger, . Uwe Pohlen

Asian Journal of Surgery (2014). Vol. 37

Abstract
Anastomotic insufficiency is associated with increased morbidity and mortality. A collagen fleece that supports anastomosis is effective for preventing anastomosis insufficiency. The objective of this study was to compare between the stability of sutured anastomoses and that of anastomoses sealed with a thrombin/fibrinogen-coated collagen fleece in a rat peritonitis model. In 72 male Wistar rats, peritonitis was induced with a specially prepared human fecal solution. Surgery at the rectosigmoid junction was performed 24–36 hours later. The different anastomotic techniques used were circular sutured anastomoses, semicircular sutured anastomosis and closure of the anterior wall with collagen patch, and complete closure with a collagen fleece. Bursting pressure, histology of anastomosis, mRNA expression of collagen types I and III, matrix metalloproteinase-13, and vascular endothelial growth factor (VEGF) were investigated after 24 hours, 72 hours, and 120 hours. All animals developed peritonitis of comparable severity. There were no differences in bursting pressures between the three suture techniques after 24 hours, 72 hours, or 120 hours. Anastomoses sealed with a collagen fleece appeared to be slightly less stable only at 24 hours, whereas they appeared to be more stable than semisutured or fully sutured anastomoses at 72 hours and 120 hours. Sealing with a collagen fleece was associated with an increase in granulation tissue, higher mRNA levels for collagen types I and III, and higher VEGF compared to sutured anastomoses. The use of a thrombin/fibrinogen-coated collagen fleece showed similar efficacy to conventional sutures in colorectal anastomoses in the presence of peritonitis inflammation, and may provide additional benefits due to an increase in mature granulation tissue.
Abstract
Anastomotic insufficiency is associated with increased morbidity and mortality. A collagen fleece that supports anastomosis is effective for preventing anastomosis insufficiency. [...]
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Emphysematous pyelonephritis: An 8-year retrospective review across four acute hospitals
J. Tsu, . Chun-Ki Chan, R. Chu, . In-Chak Law, . Chi-Kwan Kong, . Pak-Ling Liu, . Fu-Keung Cheung, . Ming-Kwong Yiu

Asian Journal of Surgery (2013). Vol. 36

Abstract
To retrospectively review our experience of managing patients with emphysematous pyelonephritis (EPN). Case notes of patients with EPN were reviewed. The patients' demographic data, clinical presentation, investigation findings, treatment, and outcome were studied. Twelve patients were diagnosed with EPN. Majority (66.7%) of them had diabetes mellitus. All patients had been evaluated by computed tomography (CT). Using the classification proposed by Wan et al, five patients had type 1 EPN, whereas six, two, and four patients had Huang and Tseng CT class 2, 3a, and 3b EPN, respectively. Immediate nephrectomy was performed in six patients, whereas conservative treatment was adopted in the other six. In the nephrectomy group, one patient died of disseminated sepsis after a protracted course. Conservative treatment failed in three patients, who succumbed despite salvage nephrectomy in two of them. Analysis revealed that severe hyperglycemia and radiological CT class (both Wan and Huang systems) were significant predictors of mortality from EPN. Severe hyperglycemia and CT class of EPN are significant risk factors for death. CT is the investigation of choice for correct diagnosis of EPN. Additional intervention should be offered to EPN patients with Wan type 1 and Huang and Tseng class 3 CT features.
Abstract
To retrospectively review our experience of managing patients with emphysematous pyelonephritis (EPN). Case notes of patients with EPN were reviewed. The patients' demographic [...]
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Vacuum-assisted closure therapy for salvaging a methicillin-resistant Staphylococcus aureus-infected prosthetic graft
. Yoichi Hisata, . Koji Hashizume, . Kazuyoshi Tanigawa, . Takashi Miura, . Tomohiro Odate, . Yuichi Tasaki, . Kiyoyuki Eishi

Asian Journal of Surgery (2014). Vol. 37

Abstract
Infection of a vascular prosthesis after a bypass surgery is relatively rare. However, once developed, serious complications can occur, such as bleeding, sepsis, and organ ischemia, occasionally resulting in leg amputation or even death in some cases. The treatment of a vascular prosthesis infection involves the necessary removal of the infected graft, subsequently, an extra-anatomical bypass surgery is often considered. We herein report a case in which postoperative methicillin-resistant Staphylococcus aureus infection caused dehiscence of the femoral vessels and exposure of the graft vessel and anastomosed area. The infected tissue was surgically removed (debridement), and the patients condition was successfully treated by the application of a nonadherent dressing and vacuum-assisted closure therapy combined with the bridging technique.
Abstract
Infection of a vascular prosthesis after a bypass surgery is relatively rare. However, once developed, serious complications can occur, such as bleeding, sepsis, and organ [...]
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Delayed small bowel perforation following blunt abdominal trauma: A case report and review of the literature
A. Jahromi, . Lester Johnson, A. M. Youssef

Asian Journal of Surgery (2016). Vol. 39

Abstract
We report a case of delayed presentation of a small bowel perforation following blunt abdominal trauma (BAT). An initial computed tomography (CT) scan revealed that the patient (a 32-year-old man) had a mesenteric hematoma, which was managed conservatively. Four weeks later, he returned to the hospital complaining of abdominal pain. A CT scan of the abdomen showed a thickened loop of the small bowel adjacent to the mesenteric hematoma at the level of the ileum. He was discharged home, but re-presented with acute abdomen 6 weeks post-trauma. An exploratory laparotomy was performed, which showed a perforated thickened loop of the ileum forming a phlegmon in the lower abdomen. In the English medical literature, only eight other reports of delayed post-traumatic presentation of ileal/jejunal perforation following BAT have been reported. We propose that post-traumatic intestinal perforation be considered in the differential diagnosis even in patients who experience a delayed small bowel perforation following BAT.
Abstract
We report a case of delayed presentation of a small bowel perforation following blunt abdominal trauma (BAT). An initial computed tomography (CT) scan revealed that the patient [...]
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Mullerian inhibiting substance expression in papillary thyroid cancer
. Mustafa Girgin, G. Sami Kılınç, . Ibrahim Ozercan, B. Simsek, . Burcin Kavak, . Husnu Celik, . Bilgin Gurates, B. Hakan Kanat

Asian Journal of Surgery (2013). Vol. 36

Abstract
To examine the expression of Mullerian inhibiting substance (MIS) in papillary thyroid cancer. The MIS expression was examined by studying the immunohistochemistry in deparafinized sections prepared from tissue blocks of patients who were diagnosed with papillary thyroid cancer, as given in the pathology archive records (n = 23). In all the cases studied, 50% (n = 10) showed strong staining and 50% showed moderate staining. The percentage of staining was found to be 94.2 ± 3.1% in strongly stained cases and 92.2 ± 2.1% in moderately stained cases. Normal thyroid tissues neighboring the tumor did not display any staining. The MIS expression can be used as a significant tool in differential diagnosis of papillary thyroid cancer and also to shed light on its etiopathogenesis.
Abstract
To examine the expression of Mullerian inhibiting substance (MIS) in papillary thyroid cancer. The MIS expression was examined by studying the immunohistochemistry in deparafinized [...]
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Morbidity- and mortality-related prognostic factors of nontraumatic splenectomies
R. Moorjani, . Joaquin Marchena-Gomez, . Jose Casimiro-Perez, C. Roque-Castellano, . Jose Ramirez-Felipe

Asian Journal of Surgery (2014). Vol. 37

Abstract
Splenectomy is a common surgical procedure, but few reports focus on nontraumatic splenectomies. The aim of this study was to determine the predictors of morbidity and mortality of patients submitted to elective nontraumatic splenectomy. A descriptive cross-sectional study of 152 consecutive, nonselected, nontraumatic patients operated on by splenectomy between 1996 and 2010 was carried out. Clinical, laboratory, and surgical data, histological findings, perioperative mortality, and postoperative complications according to Clavien-Dindo classification, were recorded. Factors related to morbidity and mortality were analyzed. Of the 152 patients (89 male and 63 female, mean age 49.8 ± 17.8 years), 74 (48.7%) were operated on for malignant hematologic disorders, 44 for benign hematologic process, and 34 for other nonhematologic disorders. The spleen was enlarged in 95 patients (62.5%) and 78 patients (51.3%) had hypersplenism. The overall complications rate was 40.1%: Grades I and II in 27 cases (17.7%), and Grades III and IV in 23 patients (15.1%). Perioperative mortality was 7.2% (11 patients). In univariate analysis, significant negative predictors for morbidity were age (p = 0.004), anemia (p = 0.03), leukocytosis (p = 0.016), and blood transfusions (p < 0.001). In the multivariate analysis, only the need for blood transfusion remained as an independent prognostic factor (p = 0.001). Related to mortality, negative prognostic factors were age (p = 0.003), leukocytosis (p = 0.048), American Society of Anesthesiologists (ASA) score (p < 0.001), blood transfusion (p < 0.001), pleural effusion (p = 0.031), and pneumonia (p = 0.001). Pneumonia remained an independent prognostic factor of mortality (p = 0.024). Blood loss is the most important prognostic factor for postoperative complications after nontraumatic splenectomies. Pneumonia is the main prognosis factor for perioperative mortality.
Abstract
Splenectomy is a common surgical procedure, but few reports focus on nontraumatic splenectomies. The aim of this study was to determine the predictors of morbidity and mortality [...]
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Gastric outlet obstruction secondary to paraesophageal herniation of gastric antrum after laparoscopic fundoplication
. Selcuk Coskun, . Lutfi Soylu, . Mahir Sahin, . Taylan Demiray

Asian Journal of Surgery (2015). Vol. 38

Abstract
The most common causes of acute gastric outlet obstruction (GOO) are duodenal and type 3 gastric ulcers. However, mechanical or functional causes may also lead to this pathology. Acute GOO is characterized by delayed gastric emptying, anorexia, or nausea accompanied by vomiting. Herein we report a 56-year-old man diagnosed with GOO secondary to paraesophageal hiatal herniation of gastric antrum after laparoscopic fundoplication. Because of the rarity of this disease, common gastrointestinal complaints may mislead the emergency physician to diagnose a nonsurgical gastrointestinal disease if a detailed history and physical examinations are not obtained.
Abstract
The most common causes of acute gastric outlet obstruction (GOO) are duodenal and type 3 gastric ulcers. However, mechanical or functional causes may also lead to this pathology. [...]
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Intraoperative retrograde ureteroscopy during laparoscopic ureteroureterostomy: Precise localization of the lesion
. Po-Ming Chow, . Jui-Shan Hsu, . Yann-Rong Su, . Yi-Sheng Chen

Asian Journal of Surgery (2016). Vol. 39

Abstract
In a case of upper ureteral stricture refractory to laser ureterotomy, laparoscopic ureteroureterostomy was performed for resection of the stricture and reanastomosis of the ureter. Precise localization of the stricture segment was achieved by retrograde ureteroscopy performed concurrently with laparoscopy, with minimal change in the patients position.
Abstract
In a case of upper ureteral stricture refractory to laser ureterotomy, laparoscopic ureteroureterostomy was performed for resection of the stricture and reanastomosis of the [...]
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Transplantation of a 2-year-old deceased-donor liver to a 61-year-old male recipient
W. Chiu Dai, W. W. Sharr, K. S.H. Chok, T. To Cheung, J. Y.Y. Fung, A. C.Y. Chan, S. Ching Chan, C. Mau Lo

Asian Journal of Surgery (2015). Vol. 38

Abstract
The suitable size of a graft is a key element in the success of liver transplantation. A small-for-size liver graft is very likely to sustain a significant degree of injury as a result of ischemia, preservation, reperfusion, and rejection. Usually, small-for-size grafts are a concern in living-donor liver transplantation rather than in deceased-donor liver transplantation. Here, we describe the successful transplantation of a liver from a 2-year-old deceased donor to a 61-year-old male recipient who suffered from liver failure related to hepatitis B. No report of successful deceased-donor liver transplantation with discrepancies between donor and recipient age and size to such an extent has been found in the literature. Despite unusually large discrepancies, with effort in minimizing the ischemic time, revised surgical techniques, and strong regenerative power of the “young” graft, the old patients liver function gradually returned to normal. This again proves that the definition of a “suitable graft” evolves with time and experience.
Abstract
The suitable size of a graft is a key element in the success of liver transplantation. A small-for-size liver graft is very likely to sustain a significant degree of injury [...]
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Perpetuating proficiency in donor right hepatectomy for living donor liver transplantation
S. Ching Chan, A. C.Y. Chan, W. W. Sharr, K. S.H. Chok, T. To Cheung, S. Tat Fan, C. Mau Lo

Asian Journal of Surgery (2014). Vol. 37

Abstract
Donor right hepatectomy (DRH) was developed by master liver surgeons and has been applied in many liver transplant centers as the mainstay for adult living donor liver transplantation. It is a major and complex surgical operation performed on living liver donors for the benefit of liver recipients. The donors deserve the lowest though inevitable morbidity and mortality. In this study, the surgical outcomes of DRH performed by newer surgeons at an established center were studied to assess the transferability of the techniques of this standardized procedure. We studied 450 consecutive DRHs performed by 11 surgeons. Three surgeons initiated and developed the transplant program and performed the first 200 DRHs (Era I). The role of chief surgeon in the following 250 DRHs (Era II) was gradually taken up by four newer surgeons with close guidance initially. Blood loss and operation time at the end of Era I versus the beginning of Era II were 251 vs. 341 mL and 391 vs. 497 minutes. The learning curve effect in Era I did not occur in Era II. The complication rates of the last 50 cases in Era I and Era II were 16% and 24%, respectively. Era I had one donor death whereas Era II had no donor death. At an established center, DRH can be carried out safely by newer surgeons with good outcomes.
Abstract
Donor right hepatectomy (DRH) was developed by master liver surgeons and has been applied in many liver transplant centers as the mainstay for adult living donor liver transplantation. [...]
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Effects of OLV preconditioning and postconditioning on lung injury in thoracotomy
. Yuan-Da Cheng, Y. Gao, . Heng Zhang, . Chao-Jun Duan, . Chun-Fang Zhang

Asian Journal of Surgery (2014). Vol. 37

Abstract
To observe the effects of intermittent one-lung ventilation (OLV) before and after surgery on the inflammatory cytokines and biomarkers of oxidative stress in serum of lung cancer patients undergoing open thoracotomy. Between June 2011 to March 2012, 80 patients undergoing lobectomy were classified into four groups nonrandomly: Group A, control group, B, OLV preconditioning group, C, OLV postconditioning group, D, OLV preconditioning-combined-with-postconditioning group. Neutrophil granulocyte (PMN), interleukin 6 (IL-6), superoxide dismutase (SOD), and malondialdehyde (MDA) were assayed in plasma samples taken preoperatively (T1), intraoperatively (T2), and 2 hours postoperatively (T3). Comparison of T1 with T2 and T3 documented significant increase in MDA, PMN, and IL-6 levels and decrease in SOD in the control group (p < 0.01). Compared with the control group, the levels of IL-6 and MDA decreased and SOD increased significantly at T2 in the OLV preconditioning group, at T3 in the OLV preconditioning combined postconditioning group (p < 0.05). Preconditioning of intermittent OLV before thoracotomy combined with postconditioning of intermittent returning two-lung ventilation after surgery maybe alleviate systematic inflammatory response and oxidative stress for lung cancer patients.
Abstract
To observe the effects of intermittent one-lung ventilation (OLV) before and after surgery on the inflammatory cytokines and biomarkers of oxidative stress in serum of lung [...]
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The admission systemic inflammatory response syndrome predicts outcome in patients undergoing emergency surgery
. Anne Chao, . Wei-Han Chou, . Chee-Jen Chang, . Yu-Jr Lin, . Shou-Zen Fan, . An-Shine Chao

Asian Journal of Surgery (2013). Vol. 36

Abstract
To investigate the incidence of systemic inflammatory response syndrome (SIRS) on emergency department admission and the prognostic significance of SIRS in patients undergoing emergency surgery. This is a retrospective study of 889 adults who were admitted as emergency cases and were operated on within 24 hours of admission. Data on patient demography, clinical information including comorbidities, categories of surgery, American Society of Anesthesiologists physical status, SIRS score, postoperative outcomes including duration of mechanical ventilation, intensive care unit (ICU) and hospital lengths of stay, and mortality were collected. SIRS occurred in 43% of the patients and was associated with a significantly worse outcome in terms of duration of ventilator use (10.5 ± 15.4 vs. 3.5 ± 4.4 days, p < 0.001), ICU stay (11.2 ± 13.6 vs. 5.0 ± 5.4 days, p < 0.001), hospital length of stay (19.4 ± 22.4 vs. 7.1 ± 7.6 days, p < 0.001) and mortality (12.7% vs. 0.4%, p < 0.001). After adjusting for covariates (including age, gender, American Society of Anesthesiologists physical status, comorbid conditions, and surgery categories), SIRS was independently associated with higher mortality (adjusted odd ratio, 21.5, 95% confidence interval (CI), 4.9–93.2), longer ventilator duration (adjusted coefficient, 7.8, 95% CI, 3.2–12.5), longer ICU stay (adjusted coefficient, 6.2, 95% CI, 2.6–9.8) and longer hospital stay (adjusted coefficient, 9.7, 95% CI, 7.5–11.9). The presence of SIRS at admission in patients receiving emergency surgery predicted worse outcomes and higher mortality rates.
Abstract
To investigate the incidence of systemic inflammatory response syndrome (SIRS) on emergency department admission and the prognostic significance of SIRS in patients undergoing [...]
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Vasovagal reflex emergency caused by Riedels thyroiditis: A case report and review of the literature
W. Cai, H. Kang, T. Hai

Asian Journal of Surgery (2016). Vol. 39

Abstract
Riedels thyroiditis is a rare type of chronic thyroiditis, associated with fibroinflammatory process and invasion into surrounding tissues, leading to compressive symptoms. A 45-year-old man had a left thyroid mass, presenting with hypotension and bradycardia many times. He was diagnosed with vasovagal reflex caused by cervical vessel compression due to a thyroid lesion. We performed the emergency operation, and most of the left thyroid was removed to relieve the compression on cervical vessels. The result of pathology proved to be Riedels thyroiditis. The vasovagal reflex did not occur any more during the 28-month follow up, except on the 3rd day after the surgery. Six months after the thyroidectomy, the patient was found to have retroperitoneal fibrosis, diagnosed by biopsy during a laparotomy for biliary disease. Riedels thyroiditis can lead to a vasovagal episode and might not be a primary thyroid disease but rather a manifestation of the systemic disorder, multifocal fibrosclerosis.
Abstract
Riedels thyroiditis is a rare type of chronic thyroiditis, associated with fibroinflammatory process and invasion into surrounding tissues, leading to compressive symptoms. [...]
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Comparison of topical isosorbide mononitrate, topical diltiazem, and their combination in the treatment of chronic anal fissure
. Hakan Bulus, . Numan Varol, . Adnan Tas, . Ali Coskun

Asian Journal of Surgery (2013).

Abstract
Chronic anal fissure is a painful condition that is associated with an increase in internal anal sphincter pressure. The main aim of this study is to evaluate the efficacy and adverse effects of topical isosorbide 5 mononitrate and topical diltiazem, when administered either as single agents or in combination, in the treatment of anal fissure. Patients with chronic anal fissure were enrolled in the study. They were randomized into three groups: Group A (0.2% isosorbide 5 mononitrate users), Group B (2% diltiazem users), and Group C (2%diltiazem + 0.2% isosorbide 5 mononitrate users). Pain was evaluated using a visual analog scale (VAS). Level of strain during defecation was graded on a 4-point scale. A total of 55 patients were enrolled in the study. The average ages of patients in Groups A, B, and C were 37.94 ± 16.19, 42.83 ± 13.21, 40 ± 13.58 years, respectively. After treatment, pain completely abated in 55.6% of patients in Group A, 27.8% (n = 5) in Group B, and 42.1% (n = 8) in Group C. The decreases in average VAS values prior to and after treatment in Groups A, B, and C were statistically significant (p values 0.0001, 0.001, and 0.0001, respectively). Average strain scores prior to and after treatment were 2.11/0.72 for Group A, 2.17/0.94 for Group B, and 1.95/0.47 for Group C. Strain during defecation prior to and after treatment in Groups A, B, and C was statistically significant (p values 0.001, 0.001, and 0.003, respectively). Topical diltiazem and a combination of nitrate and diltiazem can be used in the treatment of anal fissure. However, the agents are not significantly superior each other.
Abstract
Chronic anal fissure is a painful condition that is associated with an increase in internal anal sphincter pressure. The main aim of this study is to evaluate the efficacy [...]
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Evaluation of two hemorrhoidectomy techniques: Harmonic scalpel and Fergusons with electrocautery
. Hakan Bulus, . Adnan Tas, . Ali Coskun, . Metin Kucukazman

Asian Journal of Surgery (2014). Vol. 37

Abstract
The prevalence of symptomatic hemorrhoidal disease is a common disease that usually needs surgery for treatment. Although conservative treatment is often enough for early stages, late stage disease usually needs surgical treatment. The most common and effective approaches used for conventional surgical treatment are harmonic scalpel (HS) and Fergusons with electrocautery hemorrhoidectomy (FEH). We aimed to use the HS device for hemorrhoidectomy in Grade III and Grade IV hemorrhoids and compare our results with FEH Enrolled into the study were 151 patients who were operated for symptomatic Grade III–IV hemorrhoids. Patients were randomized into FEH and HS groups. The present review focused on comparing HS hemorrhoidectomy versus FEH with regards to operating time, postoperative pain, duration of disease, number of issued analgesics, length of hospital stay, time to return to normal activity, and postoperative complications. The mean ages of patients who underwent HS and FEH were 34.1 ± 9.2 years and 33.7 ± 8.4 years, respectively. The average postoperative stay in the HS group was 1.0 ± 0.1 days and in the FEH group was 1.2 ± 0.4 (p = 0.001). The time of return to normal activity was less for the HS groups than for the FEH groups (10.6 ± 2.1 days vs. 16.0 ± 6.3 days, p = 0.001). The mean operating time of the HS and FEH groups was 16.8 ± 4.1 minutes and 25.5 ± 7.7 minutes, respectively (p = 0.001). The total analgesic doses for the HS group were 790 ± 206 mg, 619 ± 234 mg, and 30 ± 99 mg, and for the FEH group were 1096 ± 194 mg, 1000 ± 259 mg, and 40 ± 0 mg for postoperative Day 1, Day 7, and Day 28, respectively. There was no significant difference between the HS group and the FEH group in the terms of the number of excised hemorrhoid masses (2.0 ± 0.6 vs. 1.88 ± 0.6). HS hemorrhoidectomy is safe and effective, causes less blood loss and postoperative pain, and fewer complications compared to FEH.
Abstract
The prevalence of symptomatic hemorrhoidal disease is a common disease that usually needs surgery for treatment. Although conservative treatment is often enough for early [...]
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Internal sphincterotomy versus topical nitroglycerin ointment for chronic anal fissure
M. I. Aslam, . Arif Pervaiz, . Rodrigo Figueiredo

Asian Journal of Surgery (2014). Vol. 37

Abstract
Anal fissure is a common benign condition. An anorectal problem is defined as a split in the anal canal mucosa that extends from the dentate line to the anal verge. Chronic anal fissure is defined by a history of symptoms present for more than 2 months' duration and with a triad of external skin tags, namely, a hypertrophied anal papilla, an ulcer with rolled edges, and a base exposing the internal sphincter. Because complications such as incontinence are associated with surgical treatment, chemical sphincterotomy is currently favored. The objective of this study is to compare the difference in outcome between open partial lateral anal sphincterotomy and application of topical 0.2% nitroglycerin ointment for the treatment of chronic anal fissure. This was a quasi-experimental study carried out between January 16, 2007 and January 15, 2008 in the Surgical Department of Jinnah Hospital, Lahore, Pakistan. Sixty consecutive cases with a clinical diagnosis of chronic anal fissure were recruited in the study. All recruited patients met the study inclusion criteria and were randomly assigned to one of the two groups. Group A was managed conservatively using topical 0.2% nitroglycerin ointment, whereas Group B underwent open partial lateral anal sphincterotomy. Both groups were followed up at 1 week, 2 weeks, 4 weeks, and 6 weeks after the treatment. All the patients complained of pain. A total of 43 (71.7%) patients had pain with constipation, whereas 31 (51.7%) patients had bleeding per rectum. Upon clinically examining the anal area, tenderness was elicited in all 60 (100%) patients. Group A included 30 (11 females and 19 males) cases treated with topical 0.2% nitroglycerin ointment and Group B included 30 (11 females and 19 males) cases who underwent open partial lateral anal sphincterotomy. In Group A, only 15 patients with fissures were successfully treated (50%). By contrast, 28 (93%) patients with fissures in Group B were successfully treated, and only two (7%) remained uncured. These two patients (6.6%) in Group B suffered from incontinence due to flatus and feces as a complication of the procedure. This quasi-experimental study demonstrates that open partial lateral internal sphincterotomy is superior to topical 0.2% nitroglycerin application in the treatment of chronic anal fissure, with good symptomatic relief, high rate of healing, fewer side effects, and a very low rate of early continence disturbances.
Abstract
Anal fissure is a common benign condition. An anorectal problem is defined as a split in the anal canal mucosa that extends from the dentate line to the anal verge. Chronic [...]
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Upregulation of the proinflammatory cytokine-induced neutrophil chemoattractant-1 and monocyte chemoattractant protein-1 in rats' intestinal anastomotic wound healing—Does it matter?
M. Alzoghaibi, A. M. Zubaidi

Asian Journal of Surgery (2014).

Abstract
The proinflammatory cytokines and growth-promoting factor are essential components of the wound healing process. We hypothesized that under healthy conditions, faster healing of intestinal anastomotic wound is due to an early upregulation of proinflammatory cytokines, cytokine-induced neutrophil chemoattractant-1 (CINC-1) that is followed by a quicker upregulation of homeostatic chemokine, monocyte chemoattractant protein-1 (MCP-1) and late upregulation of transforming growth factor (TGF-β). We characterized the time course of CINC-1, MCP-1 and TGF-β release at four wounds (skin, muscle, small bowel, and colonic anastomosis) after surgery on 38 juvenile male Sprague Dawley rats. The tissue samples of each site were harvested at 0 (control), 1, 3, 5, 7 and 14 days postoperatively (n = 6–8/group) and analyzed by ELISA kits for CINC-1, MCP-1 and TGF-β. CINC-1 expression peaked earlier in muscle and colonic wounds when compared to skin and small bowel. MCP-1 levels were elevated early in skin and muscle wounds, but later expression of MCP-1 was shown in colonic wounds. TGF-β levels were unchanged in all wound sites. An earlier peak in CINC-1 levels and later expression of MCP-1 were seen in colonic wounds, but no significant increase in TGF-β levels was observed. These findings support the early healing process in intestinal anastomotic wounds.
Abstract
The proinflammatory cytokines and growth-promoting factor are essential components of the wound healing process. We hypothesized that under healthy conditions, faster healing [...]
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Acute appendicitis: Diagnostic accuracy of Alvarado scoring system
Z. Ali Memon, . Saboohi Irfan, . Kanwal Fatima, M. Saud Iqbal, . Waqas Sami

Asian Journal of Surgery (2013). Vol. 36

Abstract
To evaluate the usefulness of the Alvarado scoring system in reducing the percentage of negative appendectomy in our unit. A cross-sectional study was conducted, comprising 110 patients, admitted to Surgical Unit I, Civil Hospital, Karachi, in 2011 with a preliminary diagnosis of acute appendicitis. Patients of both sexes and all age groups except younger than 10 years were included in the study and their Alvarado scores calculated, on the basis of which patients were divided into two groups: Group A (Alvarado score
Abstract
To evaluate the usefulness of the Alvarado scoring system in reducing the percentage of negative appendectomy in our unit. A cross-sectional study was conducted, comprising [...]
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Hyperparathyroid crisis: The timing of surgery
. Hsin-Hsien Yu, . Shih-Yin Lou, . Yenn-Hwei Chou, . Hon-Man Chan, . Hwa-Tzong Chen, . Shih-Ming Huang

Asian Journal of Surgery (2011). Vol. 34

Abstract
Hyperparathyroid crisis is a rare, critical, and potentially fatal disease. The aim of this study was to classify different clinical courses of this disease, according to their preoperative medical responses and suggest the proper timing for surgery. Patients who had undergone parathyroidectomies for hyperparathyroid crisis, were enrolled between January 1, 1994 and January 31, 2009. Preoperative medical treatment and responses in terms of predisposing factors, preoperative localization, operative and pathological findings, postoperative outcome, and intervals from medicine to surgery, were retrospectively reviewed. A total of 11 patients, receiving more than 72 hours of medical treatment, were divided into three types by preoperative medical responses. These included: Type I (three patients were resistant to medicine with persistent serum Ca > 14 mg/mL and were eventually treated with emergency surgery, two died of postoperative respiratory and hepatic failure), Type II (six patients with abnormal serum Ca < 14 mg/mL) and Type III (two patients in whom serum calcium returned to normal preoperatively. One patient was successfully treated with emergency surgery 18 hours post-hospitalization). We found no method for predicting the medical response, but all Type I patients exhibited high serum Ca >14 mg/mL after 48 hours of medical treatment. All abnormal parathyroid glands were >1.8 cm in length and easily detectable using preoperative ultrasonography. Because the response to pharmaceutical treatment of hyperparathyroid crisis is unpredictable, relieving the patient’s dehydration is necessary first. Making a definite diagnosis and performing an early parathyroidectomy within 48 hours are then required, especially in patients exhibiting poor medical response.
Abstract
Hyperparathyroid crisis is a rare, critical, and potentially fatal disease. The aim of this study was to classify different clinical courses of this disease, according to [...]
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Calcium content of different compositions of gallstones and pathogenesis of calcium carbonate gallstones
. Ji-Kuen Yu, . Huichin Pan, . Shing-Moo Huang, . Nan-Lan Huang, . Chung-Chin Yao, . Kuang-Ming Hsiao, . Chew-Wun Wu

Asian Journal of Surgery (2013). Vol. 36

Abstract
Our aim was to investigate the calcium content of different gallstone compositions and the pathogenic mechanisms of calcium carbonate gallstones. Between August 2001 and July 2007, gallstones from 481 patients, including 68 calcium carbonate gallstones, were analyzed for total calcium content. Gallbladder bile samples from 33 cases and six controls were analyzed for pH, carbonate anion level, free-ionized calcium concentration and saturation index for calcium carbonate. Total calcium content averaged 75.6 %, 11.8 %, and 4.2 % for calcium carbonate, calcium bilirubinate and cholesterol gallstones. In 29.4 % of patients, chronic and/or intermittent cystic duct obstructions were caused by polypoid lesions in the neck region and 70.6 % were caused by stones. A total of 82 % of patients had chronic low-grade inflammation of the gallbladder wall and 18.0 % had acute inflammatory exacerbations. In the bile, we found the mean pH, mean carbonate anion, free-ionized calcium concentrations, and mean saturation index for calcium carbonate to be elevated in comparison to controls. From our study, we found chronic and/or intermittent cystic duct obstructions and low-grade GB wall inflammation lead to GB epithelium hydrogen secretion dysfunction. Increased calcium ion efflux into the GB lumen combined with increased carbonate anion presence increases SI_CaCO3 from 1 to 22.4. Thus, in an alkaline milieu with pH 7.8, calcium carbonate begins to aggregate and precipitate.
Abstract
Our aim was to investigate the calcium content of different gallstone compositions and the pathogenic mechanisms of calcium carbonate gallstones. Between August 2001 and July [...]
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Computed tomography indices and criteria for the prediction of esophageal variceal bleeding in survivors of biliary atresia awaiting liver transplantation
. Cheng-Ta Yang, . Huey-Ling Chen, M. Chih Ho, S. Peng

Asian Journal of Surgery (2011). Vol. 34

Abstract
About 20% of biliary atresia (BA) survivors have attacks of esophageal variceal bleeding. We propose a method to evaluate the risk of esophageal variceal bleeding (EVB) using noninvasive indices by multislice computed tomography (CT). We reviewed 31 potential living-related liver recipients aged 99–5314 days (mean, 1474 days) who underwent CT examinations using a 64-slice multislice CT scanner. Of the 31 patients, 19 patients (Group A) with fecal occult blood had EVB on esophagogastroduodenoscopy, the rest belonged to Group B. Splenic diameters (mm) were divided by body heights (m) and platelet counts (1000/mm3) to produce standardized ratios of transverse splenic length/body height/platelet count (SLHPR). The transverse diameters of paraesophageal veins (PVs) and perigastric veins (PGVs) were measured adjacent to the lower thoracic esophagus and within the lesser sac, respectively. According to a receiver operating characteristic curve analysis, the SLHPRs (r = 0.833), transverse PV (r = 0.957), and PGV (r = 0.987) diameters were better predictors of EVB than demographic and laboratory variables. However, the transverse diameters of PGVs and PVs were the most accurate predictors of the EVB. For candidates awaiting liver transplantation, screening by noninvasive SLHPR and the transverse diameters of PGVs and PVs by CT may help to identify BA patients with a high risk of EVB.
Abstract
About 20% of biliary atresia (BA) survivors have attacks of esophageal variceal bleeding. We propose a method to evaluate the risk of esophageal variceal bleeding (EVB) using [...]
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A rare complication of Meckels diverticulum: A fistula between Meckels diverticulum and the appendix
. Ping-Fu Yang, . Chau-Yun Chen, . Fang-Jung Yu, . Sheau-Fang Yang, Y. Ting Chen, . Li-Chun Kao, . Jaw-Yuan Wang

Asian Journal of Surgery (2012). Vol. 35

Abstract
Meckel diverticulum is the most common congenital anomaly of the small intestine, occurring in about 2%–4% of the population. Meckel diverticulum results from incomplete closure of the omphalomesenteric duct. The presentation of symptomatic Meckel diverticulum includes gastrointestinal hemorrhage, intestinal obstruction, volvulus, intussusception, diverticulitis, and neoplasms. The development of fistula is an extremely rare complication. Previous literature has even shown an enterocolonic fistula, a vesicodiverticular fistula, ileorectal fistula, and fistula-in-ano. To the best of our knowledge, we present the first case of the fistula complicated between Meckel diverticulum and the appendix in a review of the English literature.
Abstract
Meckel diverticulum is the most common congenital anomaly of the small intestine, occurring in about 2%–4% of the population. Meckel diverticulum results from incomplete [...]
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Waist circumference is an independent risk factor for prostatic hyperplasia in Taiwanese males
. Hsu-Han Wang, . Chi-Jeng Hsieh, . Kuo-Jen Lin, . Sheng-Hsien Chu, . Cheng-Keng Chuang, . Hsiao-Wen Chen, . Min-Li Hsieh, . Ta-Min Wang, Y. Chen, . Kuan-Lin Liu, . Hsin-Chien Huang, . Yu-Chao Hsu, . Yang-Jen Chiang

Asian Journal of Surgery (2011). Vol. 34

Abstract
Benign prostatic hyperplasia is a common disease affecting older males. As obesity becomes an increasing problem worldwide, its role in prostatic hypertrophy has been discussed recently. The purpose of this study is to evaluate the relationship between waist circumferences and prostatic hyperplasia in Taiwan. There were 539 men enrolled in the study who had health examinations at the Healthcare Center of Chang Gung Memorial Hospital, 53 were excluded because of history of conditions affecting prostatic volume. Their anthropometry was measured and serum prostate-specific antigen (PSA) levels as well as lipid profiles were analyzed. Prostate volume was measured by transrectal ultrasonography performed by experienced urologists. The mean prostate volume was 26.43 mL, whereas mean body mass index (BMI) was 25.27 kg/m2 and mean waist circumference (WC) was 90.81 cm. By age-adjusted logistic regression, PSA > 4 ng/mL, WC ≥ 90 cm, and BMI > 24 kg/m2 are associated with increased risk of developing prostatic hyperplasia, only WC ≥ 90 cm can be validated by multiple logistic regression. Further analysis of obesity patterns showed that abdominal overweight/obesity places patients at increased risk independently rather than high WC or high BMI alone. Study results showed that waist circumference ≥ 90 cm is an independent risk factor of prostatic hyperplasia in Taiwan. Men with abdominal overweight/obesity (WC ≥ 90 cm and BMI > 24 kg/m2) have a twofold risk of developing prostatic hyperplasia.
Abstract
Benign prostatic hyperplasia is a common disease affecting older males. As obesity becomes an increasing problem worldwide, its role in prostatic hypertrophy has been discussed [...]
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Use of the modified double-stapling technique with vertical division of the rectum during a sphincter-preserving operation for the treatment of a rectal tumor
. Masahiro Tsubaki, Y. Ito, . Masanori Fujita, . Hiroyuki Kato

Asian Journal of Surgery (2012). Vol. 35

Abstract
The modified double-stapling technique (DST) with vertical division of the rectum(IO-DST) has been reported as a feasible and safe procedure for performing low anastomosis during rectal cancer surgery. In this procedure, an endostapler was vertically used, instead of using a horizontally orientated linear stapler, when dividing the rectum. A previous study reported that this technique is useful for treating patients with a narrow pelvis and/or performing a very low anastomosis. The use of IO-DST anastomosis during anterior resection(AR) and low anterior resection was performed on 80 cases of rectal cancer between April 1998 and June 2004 at our institution. We reviewed those cases and evaluated the leakage rate. We found that leakage occurred in six cases (7.5%), however, leakage was not found in cases of AR or cases with a preserved left colic artery (LCA). The IO-DST technique is an adequate procedure for performing AR. The preservation of the LCA could be used to prevent leakage.
Abstract
The modified double-stapling technique (DST) with vertical division of the rectum(IO-DST) has been reported as a feasible and safe procedure for performing low anastomosis [...]
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Delayed life-threatening upper gastrointestinal bleeding as a complication of laparoscopic adjustable gastric banding: Case report and review of the literature
F. C. Torab, A. F. Hefny, . Mazen Taha, . Hassan Abou-Rebyeh, F. M. Abu-Zidan

Asian Journal of Surgery (2012).

Abstract
Morbid obesity is a common health problem worldwide. Laparoscopic adjustable gastric banding has been used extensively around the world for the treatment of morbid obesity. Life-threatening hemorrhage as a late complication of laparoscopic adjustable gastric banding is extremely rare. We report a case of massive upper gastrointestinal bleeding due to intragastric erosion of a gastric band 6 years postoperatively and review the English literature on this life-threatening rare condition. Initially, the patient was aggressively resuscitated and treated conservatively. After 1 year, the band was removed laparoscopically following an unsuccessful attempted removal by endoscopy. Clinicians who follow up patients with gastric banding should be aware of this condition. The early detection of erosion is important to avoid this serious complication.
Abstract
Morbid obesity is a common health problem worldwide. Laparoscopic adjustable gastric banding has been used extensively around the world for the treatment of morbid obesity. [...]
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Functional survival after acute care for severe head injury at a designated trauma center in Hong Kong
B. B.T. Taw, A. C.S. Lam, F. L.Y. Ho, K. Hung, W. Lui, G. Leung

Asian Journal of Surgery (2012). Vol. 35

Abstract
Severe head injury is known to be a major cause of early mortalities and morbidities. Patients' long-term outcome after acute care, however, has not been widely studied. We aim to review the outcome of severely head-injured patients after discharge from acute care at a designated trauma center in Hong Kong. This is a retrospective study of prospectively collected data of patients admitted with severe head injuries between 2004 and 2008. Patients' functional status post-discharge was assessed using the Extended Glasgow Outcome Score (GOSE). Of a total of 1565 trauma patients, 116 had severe head injuries and 41 of them survived acute hospital care. Upon the last follow-up, 23 (56.1%) of the acute-care survivors had improvements in their GOSE, six (11.8%) experienced deteriorations, and 12 (23.5%) did not exhibit any change. The greatest improvement was observed in patients with GOSE of 5 and 6 upon discharge, but two of the 16 patients with GOSE 2 or 3 also had a good recovery. On logistic regression analysis, old age and prolonged acute hospital stay were found to be independent predictors of poor functional outcome after a mean follow-up duration of 42 months. Multidisciplinary neurorehabilitation service is an important component of comprehensive trauma care. Despite significant early mortalities, a proportion of severely head-injured patients who survive acute care may achieve good long-term functional recovery.
Abstract
Severe head injury is known to be a major cause of early mortalities and morbidities. Patients' long-term outcome after acute care, however, has not been widely studied. We [...]
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Treating thrombotic prosthetic arteriovenous access with cross-balloon occlusive thrombolysis and angioplasty
S. Sun, . Heng-Wen Chou, . Jer-Shen Chen, . Chih-Yang Chan

Asian Journal of Surgery (2012). Vol. 35

Abstract
Clot embolism remains a concern due to flushing of clot and thrombolytic agent centrally in the process of percutaneous pharmacomechanical thrombolysis (PMT) for a thrombosed prosthetic arteriovenous access (PAVA), which might be reduced by a modified technique. We retrospectively review this modified technique that uses two balloon-catheters in crisscross fashion and occludes both ends of PAVA during thrombolysis. Underlying stenotic lesions were dilated simultaneously with balloon angioplasty when needed. Among the 23 patients treated, 21 (91.3%), 10 (43.5%), and seven (30.4%) presented significant stenosis at the outflow, intragraft, and inflow segments of PAVA, respectively. The median duration of follow-up was 310.0 (range, 288.0–327.0) days. Anatomic success was achieved in 12 out of 23 (52.2%). Clinical success for successful dialysis was achieved in all patients. The median primary patency and secondary patency were 126.0 days (range, 7.0–316.0) days and 308.0 days (range, 84.0–327.0), respectively. We believe this method is safe and effective in dissolving PAVA thrombus as well as treating culprit stenosis. It may reduce concerns of flushing of clot and thrombolytic agent into the central circulation in the process of PMT.
Abstract
Clot embolism remains a concern due to flushing of clot and thrombolytic agent centrally in the process of percutaneous pharmacomechanical thrombolysis (PMT) for a thrombosed [...]
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Prediction of major postoperative complications and survival for locally advanced esophageal carcinoma patients
. Somkiat Sunpaweravong, . Sakchai Ruangsin, S. Laohawiriyakamol, . Somrit Mahattanobon, . Alan Geater

Asian Journal of Surgery (2012). Vol. 35

Abstract
Predicting the major complications after esophagectomy is important and may help in preselecting patients who are most likely to benefit from surgery, especially in locally advanced esophageal cancer patients who have poor prognosis. To identify the factors associated with the development of pneumonia and anastomotic leakage complications, and the survival characteristics in locally advanced esophageal cancer patients. A consecutive series of 232 locally advanced esophageal cancer patients (183 men and 49 women, median age 63 years) who underwent esophagectomy at Prince of Songkla University Hospital between 1998 and 2007 was analyzed. There were nine (3.8%) 30-day mortalities. Pneumonia occurred in 53 patients (22.8%) and anastomotic leakage in 37 patients (15.9%). Multivariate analyses showed that low body mass index was related to leakage (p = 0.015), while soft-diet dysphagia (p = 0.009), forced expiratory volume in 1 second
Abstract
Predicting the major complications after esophagectomy is important and may help in preselecting patients who are most likely to benefit from surgery, especially in locally [...]
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Laparoscopic versus open distal pancreatectomy: A meta-analysis
. Cheng-Jun Sui, B. Li, . Jia-Mei Yang, . Shuang-Jia Wang, . Yan-Ming Zhou

Asian Journal of Surgery (2012). Vol. 35

Abstract
Laparoscopic distal pancreatectomy (LDP) is a minimally invasive surgical technique. The aim of the present study was to evaluate the currently available literature and compare the short-term clinical outcomes of patients who underwent LDP for left-sided pancreatic pathology with patients who underwent traditional open surgery. A literature search was performed to identify and compare studies that reported the clinical outcomes of both LDP and open distal pancreatectomy (ODP). Pooled odds ratios (OR) and weighted mean differences (WMD) with 95% confidence intervals (95% CI) were calculated using either fixed-effects or random-effects models. Nineteen nonrandomized controlled studies were identified that matched the selection criteria and reported the clinical outcomes of 1935 patients, of whom 805 underwent LDP and 1130 underwent ODP. Compared with open surgery, reports on laparoscopic resection indicate potentially favorable outcomes in terms of operative blood loss (WMD: -273.11, 95% CI: -404.61 to -141.61), the requirement of a blood transfusion (OR: 0.28, 95% CI: 0.11–0.71), postoperative time until oral intake (WMD: -1.19, 95% CI: -1.87 to -0.50), time to first flatus (WMD: -1.03, 95% CI: -1.93 to -0.12), length of hospital stay (WMD: -3.87, 95% CI: -5.06 to -2.68), and overall morbidity (OR: 0.70, 95% CI: 0.56–0.87). There were no differences in terms of the extent of oncologic clearance and postoperative mortality. LDP results in a faster postoperative recovery and a comparable oncologic clearance in comparison with open surgery. Additional large trials are required to delineate the long-term clinical outcomes of patients diagnosed with malignant neoplasms who undergo either of these two surgeries.
Abstract
Laparoscopic distal pancreatectomy (LDP) is a minimally invasive surgical technique. The aim of the present study was to evaluate the currently available literature and compare [...]
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Great saphenous vein aneurysm presenting as an inguinal hernia
. Erdal Simsek, . Onursal Bugra

Asian Journal of Surgery (2014). Vol. 37

Abstract
A primary aneurysm in the saphenous vein is very rare. This case study is based on a 55-year-old male patient who applied for general surgery with a complaint of swelling in his left inguinal area, after examinations led to a provisional diagnosis of inguinal hernia. It was decided that surgery was the best option due to the risk of thromboembolism, and pain caused by the condition itself. Confusion with inguinal hernia can affect prognosis. It increases the risk of thromboembolism as well as preventing the chance of early response.
Abstract
A primary aneurysm in the saphenous vein is very rare. This case study is based on a 55-year-old male patient who applied for general surgery with a complaint of swelling [...]
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Results of surgical resection for patients with thymoma according to World Health Organization histology and Masaoka staging
. Shinji Shinohara, . Takeshi Hanagiri, T. So, . Manabu Yasuda, . Masaru Takenaka, . Yoshika Nagata, . Hidehiko Shimokawa, . Makoto Nakagawa, . Hidetaka Uramoto, T. So, . Fumihiro Tanaka

Asian Journal of Surgery (2012). Vol. 35

Abstract
Thymomas are relatively rare tumors. In this study, we investigated the clinical features of patients who underwent surgical resection for thymoma. This study clinicopathologically evaluated 54 consecutive patients who underwent a surgical resection of thymoma in our department between 1994 and 2006. A complete resection was performed in 52 patients, while two patients underwent an incomplete resection due to pleural dissemination. Combined resection with adjacent organs was performed for the lung (n = 6), pericardium (n = 5), and large vessels (brachiocephalic vein in three, superior vena cava in two). The concomitant autoimmune diseases were observed in 20 patients (37%), and they included myasthenia gravis in 17 patients, macroglobulinemia in one, pemphigus vulgaris in one, and stiff person syndrome in one patient. The histologic types of the World Health Organization classification diagnosed as type A in four patients, type AB in 14, type B1 in eight, type B2 in 15, and type B3 in 11. There were 27, 17, eight, and two patients with Masaoka stages I, II, III, and IV, respectively. Four patients died, and the causes of death included recurrence of thymoma in two, gastric carcinoma in one, and respiratory failure due to myasthenia gravis in one patient. The overall survival rate at 10 years was 94.6% in patients with stages I and II disease and 77.1% in patients with stages III and IV disease. Long-term survival can be expected not only for patients at early stages, as well as for patients with stages III and IV disease if surgical resection is completed macroscopically.
Abstract
Thymomas are relatively rare tumors. In this study, we investigated the clinical features of patients who underwent surgical resection for thymoma. This study clinicopathologically [...]
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Effects of clinoptilolite treatment on oxidative stress after partial hepatectomy in rats
. Kaya Saribeyoglu, . Erman Aytac, . Salih Pekmezci, . Seha Saygili, . Hafize Uzun, . Gulsen Ozbay, . Seval Aydin, H. Oktay Seymen

Asian Journal of Surgery (2011). Vol. 34

Abstract
Clinoptilolite is a natural zeolite crystal. Cytoprotective effects of clinoptilolite have been reported. However, so far there are no data about the effects of clinoptilolite treatment on oxidative stress after partial hepatectomy. In this experimental study, the effects of clinoptilolite treatment after partial hepatectomy on oxidative stress were evaluated. There were four experimental groups (n = 8): Group S, the sham group, Group H, the hepatectomy group, Group HC, the clinoptilolite treatment after partial hepatectomy group, and Group CS, the clinoptilolite-treated sham group. A 70% partial hepatectomy was performed for Group H and HC. Clinoptilolite (5 mg/kg) was given to the rats orally (via gavage tube) twice a day for 10 days after hepatectomy. Malondialdehyde (MDA), Cu-Zn super oxide dismutase (SOD), and glutathione (GSH) levels were assessed to evaluate oxidative stress. Plasma and liver tissue MDA levels of Group HC were significantly lower than the H group (p = 0.018 and p = 0.000, respectively). Liver tissue Cu-Zn SOD activity and GSH levels of Group HC were significantly higher than Group H (p = 0.003, p = 0.007, respectively). Clinoptilolite administration reduces oxidant activity and supports antioxidant response after partial hepatectomy.
Abstract
Clinoptilolite is a natural zeolite crystal. Cytoprotective effects of clinoptilolite have been reported. However, so far there are no data about the effects of clinoptilolite [...]
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Single port laparoscopic nephrolithotomy in a double collecting system kidney: The first case reported in Thailand
. Premsant Sangkum, . Wisoot Kongchareonsombat, . Suthep Patcharatrakul, . Charoen Leenanupunth, . Suchart Chaimuangraj

Asian Journal of Surgery (2012). Vol. 35

Abstract
The objective of this study is to report the first case in Thailand of a single port laparoscopic nephrolithotomy in a double collecting system of a right kidney. The operation was successfully done in a 49-year-old Thai female presented with a full staghorn kidney stone in the lower moiety of the duplex right kidney. Percutaneous nephrolithotomy was performed first but the removal of the lower calyceal branch and the rest failed because the access tract was lost. Then the residual stones were successfully removed by single port laparoscopic nephrolithotomy. This study proves that single port laparoscopic nephrolithotomy is technically feasible without additional skin incisions.
Abstract
The objective of this study is to report the first case in Thailand of a single port laparoscopic nephrolithotomy in a double collecting system of a right kidney. The operation [...]
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Management of peri-anal giant condyloma acuminatum—A case report and literature review
. Farouk Safi, . Omar Bekdache, . Suhail Al-Salam, . Mouied Alashari, . Taha Mazen, . Haytham El-Salhat

Asian Journal of Surgery (2013). Vol. 36

Abstract
Giant condyloma acuminatum (GCA), originally described by Buschke and Loewenstein in 1925 as a lesion of the penis, is more rarely seen in the anorectum and is characterized by clinical malignancy in the face of histologic benignity, however, malignant transformation to frankly invasive squamous-cell carcinoma has been described in about one-third of patients. In addition, malignant transformation has been reported in patients with "ordinary" condylomata acuminata. Human papillomavirus, known to cause condylomata acuminata, is also known to induce these tumors and was found in 96% of 63 cases reviewed in the last 10 years. These lesions have a propensity for recurrence and a likelihood of malignant transformation, and lead to significant mortality. Therefore, early and radical R0 excision, along with vigilant follow-up, provides the hope for cure. Conservative and/or multimodal therapy has been reported in a few cases, but its effect is not yet proved. The authors report one case of GCA, in addition, they reviewed the literature over the last 10 years and compared with previous reviews.
Abstract
Giant condyloma acuminatum (GCA), originally described by Buschke and Loewenstein in 1925 as a lesion of the penis, is more rarely seen in the anorectum and is characterized [...]
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Prognostic factors in Fournier gangrene
. Jaime Ruiz-Tovar, . Luis Córdoba, J. Manuel Devesa

Asian Journal of Surgery (2012). Vol. 35

Abstract
Fournier gangrene is a necrotizing fasciitis, arising in the genital and perineal area. This entity is still associated with a high mortality rate despite improvements in antibiotic and surgical treatment. This is a retrospective study of all the patients diagnosed and surgically treated for Fournier gangrene at General University Hospital Ramon y Cajal between 1988 and 2008. Possible prognostic factors that could have any influence on the evolution of Fournier gangrene were analyzed. Seventy patients were analyzed, 62 males (88.6%) and 8 females (11.4%) with a mean age of 57.9 ± 13.5 years. Most frequent clinical manifestations were perineal pain (82.9%) and fever (60%). Physical examination revealed edema (91.4%), erythema (88.6%) and perineal skin necrosis (60%). All the patients underwent surgical debridement of necrotic tissue. In 54.3% reoperations were necessary for new surgical debridements. Medical complications rate was 27.1% and mortality one 22.9%. Ethylism, coexistence of neoplasms, presence of skin necrosis, myonecrosis, abdominal wall affection, number of debrided areas, reoperations, concentration of creatinine in serum>1.4 mg/dL, and hemoglobin
Abstract
Fournier gangrene is a necrotizing fasciitis, arising in the genital and perineal area. This entity is still associated with a high mortality rate despite improvements in [...]
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Surgical morbidity in obese children
. Stylianos Roupakias, . Paraskevi Mitsakou

Asian Journal of Surgery (2012). Vol. 35

Abstract
In recent years, there has been a worldwide increase in childhood obesity. At present, pediatric surgeons manage a greater number of pediatric patients who are significantly overweight. Little data exist regarding the surgical challenges of obese children. This review study was designed to examine the relationship of obesity to surgical comorbidities, postoperative complications, and perioperative outcome in children, and to pediatric trauma. Obesity seems to be an independent risk factor in surgical-related pediatric morbidity and should be considered an important variable when looking at surgical outcomes in the pediatric population. Identification by and awareness among pediatric surgeons, of increased risk factors for peri/postoperative complications, will be crucial in optimizing the hospital stay and outcome of these children.
Abstract
In recent years, there has been a worldwide increase in childhood obesity. At present, pediatric surgeons manage a greater number of pediatric patients who are significantly [...]
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Neoadjuvant chemotherapy and salvage surgery for an aldosterone-producing adrenal carcinoma with inferior vena cava thrombus: Case report and literature review
. Carlos Rangel, . Gabrielle Scattolin, S. Pais-Costa, . Eduardo Vieira, . Eduardo Gaio

Asian Journal of Surgery (2013). Vol. 36

Abstract
Inferior vena cava (IVC) thrombus is a rare presentation of adrenal carcinoma. Hyperladosteronism is rarely associated with it. We report a case of an aldosterone-producing left adrenal carcinoma with IVC thrombus and invasion of multiple organs, treated with neoadjuvant chemotherapy and salvage surgery. The patient is alive and asymptomatic after 46 months. Surgical aspects and therapeutic options are discussed and compared with the current medical literature. This is believed to be the first report of multiple organ resection combined with IVC thrombus removal for a functioning adrenal carcinoma.
Abstract
Inferior vena cava (IVC) thrombus is a rare presentation of adrenal carcinoma. Hyperladosteronism is rarely associated with it. We report a case of an aldosterone-producing [...]
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Colonic volvulus detected by CT scan in a case with mental retardation and prune belly syndrome
. Yoichiro Oka, . Kouji Masumoto, . Masatoshi Nakamura, . Akinori Iwasaki

Asian Journal of Surgery (2011). Vol. 34

Abstract
Colonic volvulus is a rare disease in children. Delayed diagnosis of the condition can often be fatal, especially in pediatric patients with mental retardation. We herein present the case of a female pediatric patient with colonic volvulus, prune belly syndrome, and mental retardation. Preoperative CT scans showed the characteristic signs of this disease. The volvulus occurred in the proximal colon of the colostomy. The release of the colonic volvulus and reconstruction of the colostomy were performed without the resection of the ischemic colon. The postoperative clinical course was uneventful.
Abstract
Colonic volvulus is a rare disease in children. Delayed diagnosis of the condition can often be fatal, especially in pediatric patients with mental retardation. We herein [...]
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A novel duct-lobular segmentectomy for breast tumors with nipple discharge using near-infrared indocyanine green fluorescence imaging
. Tsuyoshi Ohno, . Keiji Inoue, . Shigeki Nagayoshi, . Toshio Fukuda, . Junji Irie

Asian Journal of Surgery (2013). Vol. 36

Abstract
A 44-year-old woman was referred to our hospital with pathological nipple discharge from her left breast. Ultrasonography revealed a solid tumor beneath her left areola that measured 17 mm in diameter with a dilated mammary duct. Contrast-enhanced magnetic resonance imaging showed an early-enhanced cystic tumor and a dilated mammary duct. We performed a duct-lobular segmentectomy using near-infrared indocyanine green (ICG)-fluorescence imaging. Under general anesthesia, a silicone tube was inserted into an orifice of a fluid-discharging mammary duct, and 1 mL dye-fluorescence liquid containing ICG and indigo carmine was injected into the mammary duct. A periareolar incision was made, and the fluorescence image of the demarcated mammary duct segment was obtained. The mammary duct segment was dissected, along with the demarcation line. The cystic lesion and dilated mammary duct were fully resected, and the pathological diagnosis was intraductal papilloma of the breast. We report that near-infrared ICG fluorescence could be applied for imaging of the mammary duct segment, and the fluorescence image allowed for easier duct-lobular segmentectomy for nipple discharge.
Abstract
A 44-year-old woman was referred to our hospital with pathological nipple discharge from her left breast. Ultrasonography revealed a solid tumor beneath her left areola that [...]
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Colonic obstruction after ingested gravel and stone
. P.V. Narayanan, . M.K. Balachandran

Asian Journal of Surgery (2012). Vol. 35

Abstract
This case concerns a 10-year-old boy with a history of behavioral abnormality that arrived at our surgical emergency room with acute abdominal discomfort. The boy had acute colitis-like clinical symptoms resulting from ingested and retained foreign bodies in the colon. These foreign bodies (gravel and stones) had accumulated in the entire colon over a period of 1 year. Attempts to dislodge the foreign bodies from the rectum by mechanical means failed, therefore the possibility of surgical intervention was considered in view of the worsening colitis. However, the problem was finally resolved by repeated basketting by colonoscopy, antibiotics and later laxatives. The case is noteworthy because of the extent of the condition, difficulty of the decision-making, and the relative success of watchful conservative measures.
Abstract
This case concerns a 10-year-old boy with a history of behavioral abnormality that arrived at our surgical emergency room with acute abdominal discomfort. The boy had acute [...]
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Routine use of antibiotic prophylaxis in low-risk laparoscopic cholecystectomy is unnecessary: A randomized clinical trial
J. Narayan Shah, S. Bir Maharjan, . Sanjay Paudyal

Asian Journal of Surgery (2012). Vol. 35

Abstract
Laparoscopic cholecystectomy uses smaller incision and trocars that lessen the contamination and exposure of wound, resulting in less infection. However, the antibiotic prophylaxis is still widely practiced, like in our institute, a continuation of the era of open surgery. Recent studies reveal no advantage of routine use of antibiotic, and there is growing consensus against it. Besides cost, antibiotic increases emergence of multidrug resistance. Because of the controversies, we conducted this clinical trial. This randomized clinical trial, conducted from October 1, 2009 to September 31, 2010 at Patan Hospital, included 154 patients in prophylactic antibiotic group (GrAP) with cefazolin 1 g IV as per existing practice and 156 in no antibiotic group (GrAPn). Symptomatic laparoscopic cholecystectomy patients of American Society of Anesthesiologist (ASA) 1 and 2 (without diabetes) were included. Patients with complicated gall stones (cholangitis, choledocholithiasis, and pancreatitis) and who required conversion were excluded. Wound was observed during follow-up within 1 week. Data on patient characteristics, use of antibiotic, bile spillage, and postoperative wound infection were entered in predesigned proforma. Microsoft Excel was used to analyze the data. In total, 310 patients were eligible for analysis, 154 in GrAP and 156 in GrAPn. Both groups were comparable in patient demographic and clinical characteristics such as average age (40.3 vs. 41.6 years) and sex (female 77.6% vs. 78.6%). Overall wound infection occurred in 4.8% (15/310). There was no significant difference in wound infections among the two groups (p = 0.442): GrAP 3.9% and GrAPn 5.8%. There was no mortality in this series. Routine preoperative antibiotic prophylaxis is not necessary in low-risk symptomatic gallstone patients undergoing laparoscopic cholecystectomy.
Abstract
Laparoscopic cholecystectomy uses smaller incision and trocars that lessen the contamination and exposure of wound, resulting in less infection. However, the antibiotic prophylaxis [...]
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Intraperitoneal explosion following gastric perforation
S. K. Mansfield, . Roderick Borrowdale

Asian Journal of Surgery (2014). Vol. 37

Abstract
The object of this study is to report a rare case of explosion during laparotomy where diathermy ignited intraperitoneal gas from a spontaneous stomach perforation. Fortunately, the patient survived but the surgeon experienced a finger burn. A literature review demonstrates other examples of intraoperative explosion where gastrointestinal gases were the fuel source. Lessons learned from these cases provide recommendations to prevent this potentially lethal event from occurring.
Abstract
The object of this study is to report a rare case of explosion during laparotomy where diathermy ignited intraperitoneal gas from a spontaneous stomach perforation. Fortunately, [...]
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Left-sided gallbladder: An incidental finding on laparoscopic cholecystectomy
. Amin Makni, . Houcine Magherbi, . Rachid Ksantini, W. Rebai, Z. Ben Safta

Asian Journal of Surgery (2012). Vol. 35

Abstract
Transposition of the gallbladder to the left side without situs inversus viscerum is rare. These gallbladders are situated under the left lobe of the liver between Segment III and IV or on Segment III to the left of the falciform ligament. This is a report of a 50-year-old woman who was admitted to our department with a history of pain in her right upper abdomen. The physical examination showed tenderness in the right upper quadrant of the abdomen without a Murphys sign. Abdominal ultrasonography showed gall bladder stones without dilatation of the bile ducts. The patient underwent a laparoscopic cholecystectomy using the French position and four ports positioned as usual. We discovered a left-sided gallbladder located on the left of the round ligament. The gallbladder was excised as usual. Intraoperative cholangiogram showed neither dilatation of the bile ducts nor associated congenital anomalies of the biliary tree. The patient was discharged on the first postoperative day. Because routine preoperative examinations may not detect the anomaly, the latter may take surgeons by surprise during laparoscopy. Awareness of the unpredictable confluence of the cystic duct into the common bile duct and selective use of intraoperative cholangiography both contributed to the safe laparoscopic management of this unusual problem.
Abstract
Transposition of the gallbladder to the left side without situs inversus viscerum is rare. These gallbladders are situated under the left lobe of the liver between Segment [...]
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Duodenal GIST metastasized to skull and orbit managed by surgery – A case report
. Lai-Fung Li, . Yat-Hang Tse, . Siu-Lun Ho, . Kin-Wing Yan, . Wai-Man Lui

Asian Journal of Surgery (2011). Vol. 34

Abstract
We report a 26-year-old man with 6 years, history of duodenal gastrointestinal stromal tumor (GIST) with liver, peritoneum and lung metastases. He presented with left eye ptosis, diplopia, left facial numbness and a left temporal fossa mass that was confirmed to be GIST with left skull and left orbit metastases. Craniectomy with cranioplasty, tumor excision and decompression were performed. There was an improvement of his visual symptoms and facial numbness. To our knowledge, this is one of the few reports of surgical management of GIST, metastasized to skull and orbit, with good symptomatic relief.
Abstract
We report a 26-year-old man with 6 years, history of duodenal gastrointestinal stromal tumor (GIST) with liver, peritoneum and lung metastases. He presented with left eye [...]
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Hepatic perivascular epithelioid cell tumor: Five case reports and literature review
Z. Liu, Y. Qi, . Chuanzhuo Wang, . Xiaobo Zhang, . Baosheng Wang

Asian Journal of Surgery (2015). Vol. 38

Abstract
Perivascular epithelioid cell tumor (PEComa) is a rare tumor. Here, we present data regarding clinical presentations, diagnoses, management, and prognosis of five cases of hepatic PEComa between January 2002 and December 2008. Ultrasonography showed hyperechoic masses in all patients. Precontrast computed tomography (CT) showed that all lesions scanned were heterogeneous in density and were heterogeneously enhanced in arterial phase images. In two cases, magnetic resonance imaging showed hypointensity on T1-weighted images and hyperintensity on T2-weighted images. In enhanced scanning, lesions showed asymmetrical enhancement during arterial phase imaging. All tumors were composed of varying proportions of smooth muscle, adipose tissue, and thick-walled blood vessels, and showed positive immunohistochemical staining for Human Melanoma Black-45. All patients underwent hepatectomy, and there was no evidence of recurrence or metastasis during the follow-up period.
Abstract
Perivascular epithelioid cell tumor (PEComa) is a rare tumor. Here, we present data regarding clinical presentations, diagnoses, management, and prognosis of five cases of [...]
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Survival of patients aged over 80 years after Austin-Moore hemiarthroplasty and bipolar hemiarthroplasty for femoral neck fractures
. Chen-Chiang Lin, . Shier-Chieg Huang, . Yang-Kun Ou, . Yung-Ching Liu, . Ching-Mei Tsai, . Hsin-Hui Chan, . Chen-Ti Wang

Asian Journal of Surgery (2012). Vol. 35

Abstract
Hemiarthroplasty is recommended for treatment of displaced femoral neck fractures in physically compromised elderly patients. The objective of this study was to analyze survivalof patients aged >80 years after the implantation of either an Austin-Moore type prosthesis or a bipolar bearing prosthesis. An Austin-Moore or bipolar hemiarthroplasty was implanted into 120 patients aged >80 years. Demographic data were collected. Survival rate at 5 years and factors related to mortality were analyzed. Sixty-two patients received Austin-Moore hemiarthroplasty, and 58 received bipolar hemiarthroplasty. No significant differences in gender, comorbid conditions, ASA scores, duration of hospitalization, intraoperative blood loss, duration from injury to operation, or postoperative morbidity between the two groups were found. However, patients who received the Austin-Moore hemiarthroplasty were older and had shorter operation time than those who received bipolar hemiarthroplasty. Kaplan-Meier estimates of 5 years survival were 40.0% for patients who received Austin-Moore hemiarthroplasty, and 62.9% for patients who received bipolar hemiarthroplasty. Cox proportional hazard regression analysis of risks factors of death revealed that patients who underwent Austin-Moore hemiarthroplasty were 2.0-fold more likely to die when compared to those who received bipolar hemiarthroplasty. Elderly patients who receive bipolar hemiarthroplasty may have a more favorable survival outcome when compared to those who receive unipolar hemiarthroplasty.
Abstract
Hemiarthroplasty is recommended for treatment of displaced femoral neck fractures in physically compromised elderly patients. The objective of this study was to analyze survivalof [...]
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Laparoscopic appendectomy for complicated acute appendicitis does not result in increased surgical complications
. Yueh-Ming Lin, . Ching-Hua Hsieh, . Chia-I Cheng, . Boon-Lee Tan, . Hang-Tsung Liu

Asian Journal of Surgery (2012). Vol. 35

Abstract
Septic postoperative complications are debated in patients with complicated acute appendicitis treated with laparoscopic appendectomy (LA). The aim of this study was to investigate the results of LA in both complicated and uncomplicated cases of acute appendicitis. From January to December 2009, 94 patients with acute appendicitis underwent LA by the same surgeon using the three-port technique. Data were accumulated and compared between complicated and uncomplicated acute appendicitis. Of the 94 patients (45 women and 49 men), 19 had complicated and 75 uncomplicated acute appendicitis. The group with complicated acute appendicitis, as compared to the uncomplicated group, was significantly older (55.7 ± 20.5 years vs. 41.0 ± 18.0 years), and had a significantly increased operation time (117.6 ± 45.5 minutes vs. 78.2 ± 39.4 minutes), longer length of hospital stay (9.0 ± 3.3 days vs. 5.2 ± 6.0 days) and higher conversion rate (21.1% vs. 2.7%). No increase in surgical complications was noted in patients with complicated acute appendicitis, as compared to those with uncomplicated acute appendicitis. This study demonstrated no increase in surgical complications after LA in patients with complicated acute appendicitis when compared with those who had uncomplicated disease. Therefore, LA may be considered the first-choice treatment option for both uncomplicated and complicated acute appendicitis.
Abstract
Septic postoperative complications are debated in patients with complicated acute appendicitis treated with laparoscopic appendectomy (LA). The aim of this study was to investigate [...]
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Technical modification of retroperitoneal laparoscopic adrenalectomy for primary hyperaldosteronism and clinical outcomes
. Yi-Chia Lin, . Hsin-Yi Lee, . Guang-Dar Juang, . Chung-Hsin Yeh, . Yi-Hong Cheng, . Kuang-Yu Chuo, . Hong-En Chen, . Te-Fu Tsai, T. I.S. Hwang

Asian Journal of Surgery (2013). Vol. 36

Abstract
Standard laparoscopic adrenalectomy requires early control of the main adrenal vein, however, the small retroperitoneal working space is challenging for beginners to perform this maneuver. We report a technical modification of retroperitoneal laparoscopic adrenalectomy (RLA) for primary hyperaldosteronism (PHA) and the clinical outcomes. A total of 38 RLAs were performed for the patients with PHA. The patients were placed in true lateral position with mild bending to expand the surgical field. Instead of attempting to control the main adrenal vein initially, we adopted a technical modification that manipulating and freeing the gland first before controlling the main adrenal vein. The RLAs were successfully performed in all but one case, which was converted to open surgery due to pancreatic injury. Mean operative time was 124 minutes and estimated blood loss was 74 ml. Mean maximal fluctuation of systolic blood pressure was 29 mmHg. For the right-side RLA, less operative time (113.5 vs. 137.9 minutes) and estimated blood loss (59.5 vs. 91.2 ml) were noted compared with the left-side procedure. Postoperative complications included cerebrovascular accident in one patient, one surgical site hematoma, and two patients had postoperative fever. Potassium level returned to normal in all patients and 70% of the patients reduced their antihypertensives. Technical modification RLA for PHA without initial control of the main adrenal vein is a safe and feasible procedure. No vigorous blood pressure fluctuation was intraoperatively noted. No vascular injury occurred. Moreover, the right-side procedure became easier.
Abstract
Standard laparoscopic adrenalectomy requires early control of the main adrenal vein, however, the small retroperitoneal working space is challenging for beginners to perform [...]
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Doctor–patient communication, knowledge, and question prompt lists in reducing preoperative anxiety – A randomized control study
. Leslie Lim, . Pierce Chow, . Chow-Yin Wong, . Alexander Chung, . Yiong-Huak Chan, . Wai-Keong Wong, . Khee-Chee Soo

Asian Journal of Surgery (2011).

Abstract
The aims of the study were to assess factors responsible for the reduction of preoperative anxiety in patients undergoing breast and abdominal surgeries. In particular, we investigated whether question prompt lists (QPL), patients’ knowledge, or the communication skills of surgeons had effects on anxiety reduction. Patients were randomly assigned to QPL and control groups. Anxiety was assessed on the State Trait Anxiety Inventory. Both groups showed significant reduction in anxiety between initial consultation and one day prior to surgery, with QPL patients showing a trend towards a greater reduction of anxiety after surgery and a significant reduction at the first outpatient follow-up. Satisfaction with consultation and the doctor’s ability to answer questions concerning diagnosis, and treatment were significantly associated with anxiety reduction. Effective anxiety reduction hinged on doctors’ communication abilities and patients’ satisfaction with the consultation.
Abstract
The aims of the study were to assess factors responsible for the reduction of preoperative anxiety in patients undergoing breast and abdominal surgeries. In particular, we [...]
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