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1.  Feasibility of the Short Hospital Stays after Laparoscopic Appendectomy for Uncomplicated Appendicitis 
Yonsei Medical Journal  2014;55(6):1606-1610.
Purpose
The aim of this study was to evaluate the feasibility of short hospital stays after laparoscopic appendectomy for uncomplicated appendicitis.
Materials and Methods
The records of 142 patients who underwent laparoscopic appendectomy for uncomplicated appendicitis from January 2010 to December 2012 were analyzed retrospectively. Patients were allocated to an early (<48 hours) or a late (>48 hours) group by postoperative hospital stay. Postoperative complications and readmission rates in the two groups were evaluated and compared.
Results
Overall mean patient age was 50.1 (±16.0) years, and mean hospital stay was 3.8 (±2.8) days. Fifty-four patients (group E, 38.0%) were discharged within 48 hours of surgery, and 88 patients (group L, 62.0%) stayed more than 48 hours. Overall complication rates were similar in the two groups (14.8% vs. 21.6%, p=0.318), and wound complications (13.0% vs. 12.5%), postoperative bowel obstruction (1.9% vs. 2.3%), and abdominal pain (1.9% vs. 3.4%) were not significantly different.
Conclusion
Patients that undergo laparoscopic appendectomy due to uncomplicated appendicitis may be safely discharged within 48 hours. Further study should be conducted to determine the optimal length of hospital stay after laparoscopic appendectomy to reduce hospital costs.
doi:10.3349/ymj.2014.55.6.1606
PMCID: PMC4205701  PMID: 25323898
Laparoscopic; appendectomy; hospital stay; complication
2.  Early Feeding Is Feasible after Emergency Gastrointestinal Surgery 
Yonsei Medical Journal  2014;55(2):395-400.
Purpose
This study was undertaken to assess the feasibility of early feeding in patients that have undergone emergency gastrointestinal (GI) surgery.
Materials and Methods
The authors retrospectively reviewed 84 patients that underwent emergency bowel resection and/or anastomosis from March 2008 to December 2011. Patients with severe shock, intestinal ischemia, sustained bowel perforation, or short bowel syndrome were excluded. Patients were divided into the early (group E; n=44) or late (group L; n=40) group according to the time of feeding commencement. Early feeding was defined as enteral feeding that started within 48 hours after surgery. Early and late feeding groups were compared with respect to clinical data and surgical outcomes.
Results
The most common cause of operation was bowel perforation, and the small bowel was the most commonly involved site. No significant intergroup differences were found for causes, sites, or types of operation. However, length of stay (LOS) in the intensive care unit (1 day vs. 2 days, p=0.038) and LOS in the hospital after surgery were significantly greater (9 days vs. 12 days, p=0.012) in group L than group E; pulmonary complications were also significantly more common (13.6% vs. 47.5%, p=0.001) in group L than group E.
Conclusion
After emergency GI surgery, early feeding may be feasible in patients without severe shock or bowel anastomosis instability.
doi:10.3349/ymj.2014.55.2.395
PMCID: PMC3936612  PMID: 24532509
Emergency treatment; enteral nutrition; gastrointestinal tract
3.  Perioperative Nutritional Status Changes in Gastrointestinal Cancer Patients 
Yonsei Medical Journal  2013;54(6):1370-1376.
Purpose
The presence of gastrointestinal (GI) cancer and its treatment might aggravate patient nutritional status. Malnutrition is one of the major factors affecting the postoperative course. We evaluated changes in perioperative nutritional status and risk factors of postoperative severe malnutrition in the GI cancer patients.
Materials and Methods
Nutritional status was prospectively evaluated using patient-generated subjective global assessment (PG-SGA) perioperatively between May and September 2011.
Results
A total of 435 patients were enrolled. Among them, 279 patients had been diagnosed with gastric cancer and 156 with colorectal cancer. Minimal invasive surgery was performed in 225 patients. PG-SGA score increased from 4.5 preoperatively to 10.6 postoperatively (p<0.001). Ten patients (2.3%) were severely malnourished preoperatively, increasing to 115 patients (26.3%) postoperatively. In gastric cancer patients, postoperative severe malnourishment increased significantly (p<0.006). In univariate analysis, old age (>60, p<0.001), male sex (p=0.020), preoperative weight loss (p=0.008), gastric cancer (p<0.001), and open surgery (p<0.001) were indicated as risk factors of postoperative severe malnutrition. In multivariate analysis, old age, preoperative weight loss, gastric cancer, and open surgery remained significant as risk factors of severe malnutrition.
Conclusion
The prevalence of severe malnutrition among GI cancer patients in this study increased from 2.3% preoperatively to 26.3% after an operation. Old age, preoperative weight loss, gastric cancer, and open surgery were shown to be risk factors of postoperative severe malnutrition. In patients at high risk of postoperative severe malnutrition, adequate nutritional support should be considered.
doi:10.3349/ymj.2013.54.6.1370
PMCID: PMC3809878  PMID: 24142640
General surgery; gastrointestinal neoplasm; nutrition assessment
4.  Application of negative pressure wound therapy in patients with wound dehiscence after abdominal open surgery: a single center experience 
Purpose
Since the 1990's, negative pressure wound therapy (NPWT) has been used to treat soft tissue defects, burn wounds, and to achieve skin graft fixation. In the field of abdominal surgery, the application of NPWT is increasing in cases with an open abdominal wound requiring temporary wound closure and a second look operation. In the present study, the authors analyzed patients that underwent NPWT for postoperative wound dehiscence.
Methods
The computerized records of patients that had undergone an abdominal operation from November 2009 to May 2012 were retrospectively analyzed.
Results
The number of total enrolled patients was 50, and 30 patients (60%) underwent an emergency operation. Diagnoses were as follows: panperitonitis or intra-abdominal abscess (24 cases, 48%), intestinal obstruction (10 cases, 20%), cancer (7 cases, 14%), mesentery ischemia (3 cases, 6%), and hemoperitoneum (1 case, 2%). NPWT was applied at a mean of 12.9 ± 8.2 days after surgery and mean NPWT duration was 17.9 days (2 to 96 days). The 11 patients (22%) with unsuccessful wound closure had a deeper and more complex wound than the other 39 patients (78%) (90.9% vs. 38.5%, P = 0.005). There were two complication cases (4%) due to delayed wound healing.
Conclusion
Most patients recovered well due to granulation formation and suturing. NPWT was found to be convenient and safe, but a prospective comparative study is needed to confirm the usefulness of NPWT in patients whose wounds are dehisced.
doi:10.4174/jkss.2013.85.4.180
PMCID: PMC3791361  PMID: 24106685
Negative pressure wound therapy; Vacuum-assisted closure; Surgical wound dehiscence; Abdomen; Surgery
5.  Complicated intra-abdominal infections worldwide: the definitive data of the CIAOW Study 
Sartelli, Massimo | Catena, Fausto | Ansaloni, Luca | Coccolini, Federico | Corbella, Davide | Moore, Ernest E | Malangoni, Mark | Velmahos, George | Coimbra, Raul | Koike, Kaoru | Leppaniemi, Ari | Biffl, Walter | Balogh, Zsolt | Bendinelli, Cino | Gupta, Sanjay | Kluger, Yoram | Agresta, Ferdinando | Saverio, Salomone Di | Tugnoli, Gregorio | Jovine, Elio | Ordonez, Carlos A | Whelan, James F | Fraga, Gustavo P | Gomes, Carlos Augusto | Pereira, Gerson Alves | Yuan, Kuo-Ching | Bala, Miklosh | Peev, Miroslav P | Ben-Ishay, Offir | Cui, Yunfeng | Marwah, Sanjay | Zachariah, Sanoop | Wani, Imtiaz | Rangarajan, Muthukumaran | Sakakushev, Boris | Kong, Victor | Ahmed, Adamu | Abbas, Ashraf | Gonsaga, Ricardo Alessandro Teixeira | Guercioni, Gianluca | Vettoretto, Nereo | Poiasina, Elia | Díaz-Nieto, Rafael | Massalou, Damien | Skrovina, Matej | Gerych, Ihor | Augustin, Goran | Kenig, Jakub | Khokha, Vladimir | Tranà, Cristian | Kok, Kenneth Yuh Yen | Mefire, Alain Chichom | Lee, Jae Gil | Hong, Suk-Kyung | Lohse, Helmut Alfredo Segovia | Ghnnam, Wagih | Verni, Alfredo | Lohsiriwat, Varut | Siribumrungwong, Boonying | El Zalabany, Tamer | Tavares, Alberto | Baiocchi, Gianluca | Das, Koray | Jarry, Julien | Zida, Maurice | Sato, Norio | Murata, Kiyoshi | Shoko, Tomohisa | Irahara, Takayuki | Hamedelneel, Ahmed O | Naidoo, Noel | Adesunkanmi, Abdul Rashid Kayode | Kobe, Yoshiro | Ishii, Wataru | Oka, Kazuyuki | Izawa, Yoshimitsu | Hamid, Hytham | Khan, Iqbal | Attri, AK | Sharma, Rajeev | Sanjuan, Juan | Badiel, Marisol | Barnabé, Rita
The CIAOW study (Complicated intra-abdominal infections worldwide observational study) is a multicenter observational study underwent in 68 medical institutions worldwide during a six-month study period (October 2012-March 2013). The study included patients older than 18 years undergoing surgery or interventional drainage to address complicated intra-abdominal infections (IAIs).
1898 patients with a mean age of 51.6 years (range 18-99) were enrolled in the study. 777 patients (41%) were women and 1,121 (59%) were men. Among these patients, 1,645 (86.7%) were affected by community-acquired IAIs while the remaining 253 (13.3%) suffered from healthcare-associated infections. Intraperitoneal specimens were collected from 1,190 (62.7%) of the enrolled patients.
827 patients (43.6%) were affected by generalized peritonitis while 1071 (56.4%) suffered from localized peritonitis or abscesses.
The overall mortality rate was 10.5% (199/1898).
According to stepwise multivariate analysis (PR = 0.005 and PE = 0.001), several criteria were found to be independent variables predictive of mortality, including patient age (OR = 1.1; 95%CI = 1.0-1.1; p < 0.0001), the presence of small bowel perforation (OR = 2.8; 95%CI = 1.5-5.3; p < 0.0001), a delayed initial intervention (a delay exceeding 24 hours) (OR = 1.8; 95%CI = 1.5-3.7; p < 0.0001), ICU admission (OR = 5.9; 95%CI = 3.6-9.5; p < 0.0001) and patient immunosuppression (OR = 3.8; 95%CI = 2.1-6.7; p < 0.0001).
doi:10.1186/1749-7922-9-37
PMCID: PMC4039043  PMID: 24883079
6.  Current concept of abdominal sepsis: WSES position paper 
Although sepsis is a systemic process, the pathophysiological cascade of events may vary from region to region.
Abdominal sepsis represents the host’s systemic inflammatory response to bacterial peritonitis.
It is associated with significant morbidity and mortality rates, and is the second most common cause of sepsis-related mortality in the intensive care unit.
The review focuses on sepsis in the specific setting of severe peritonitis.
doi:10.1186/1749-7922-9-22
PMCID: PMC3986828  PMID: 24674057
7.  WSES guidelines for emergency repair of complicated abdominal wall hernias 
Emergency repair of complicated abdominal hernias is associated with poor prognosis and a high rate of post-operative complications.
A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013, during the 2nd Congress of the World Society of Emergency Surgery with the goal of defining recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel.
doi:10.1186/1749-7922-8-50
PMCID: PMC4176144  PMID: 24289453
8.  2013 WSES guidelines for management of intra-abdominal infections 
Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high.
The 2013 update of the World Society of Emergency Surgery (WSES) guidelines for the management of intra-abdominal infections contains evidence-based recommendations for management of patients with intra-abdominal infections.
doi:10.1186/1749-7922-8-3
PMCID: PMC3545734  PMID: 23294512
9.  Complicated intra-abdominal infections in a worldwide context: an observational prospective study (CIAOW Study) 
Sartelli, Massimo | Catena, Fausto | Ansaloni, Luca | Moore, Ernest | Malangoni, Mark | Velmahos, George | Coimbra, Raul | Koike, Kaoru | Leppaniemi, Ari | Biffl, Walter | Balogh, Zsolt | Bendinelli, Cino | Gupta, Sanjay | Kluger, Yoram | Agresta, Ferdinando | Di Saverio, Salomone | Tugnoli, Gregorio | Jovine, Elio | Ordonez, Carlos | Gomes, Carlos Augusto | Junior, Gerson Alves Pereira | Yuan, Kuo-Ching | Bala, Miklosh | Peev, Miroslav P | Cui, Yunfeng | Marwah, Sanjay | Zachariah, Sanoop | Sakakushev, Boris | Kong, Victor | Ahmed, Adamu | Abbas, Ashraf | Gonsaga, Ricardo Alessandro Teixeira | Guercioni, Gianluca | Vettoretto, Nereo | Poiasina, Elia | Ben-Ishay, Offir | Díaz-Nieto, Rafael | Massalou, Damien | Skrovina, Matej | Gerych, Ihor | Augustin, Goran | Kenig, Jakub | Khokha, Vladimir | Tranà, Cristian | Kok, Kenneth Yuh Yen | Mefire, Alain Chichom | Lee, Jae Gil | Hong, Suk-Kyung | Lohse, Helmut Alfredo Segovia | Ghnnam, Wagih | Verni, Alfredo | Lohsiriwat, Varut | Siribumrungwong, Boonying | Tavares, Alberto | Baiocchi, Gianluca | Das, Koray | Jarry, Julien | Zida, Maurice | Sato, Norio | Murata, Kiyoshi | Shoko, Tomohisa | Irahara, Takayuki | Hamedelneel, Ahmed O | Naidoo, Noel | Adesunkanmi, Abdul Rashid Kayode | Kobe, Yoshiro | Attri, AK | Sharma, Rajeev | Coccolini, Federico | El Zalabany, Tamer | Khalifa, Khalid Al | Sanjuan, Juan | Barnabé, Rita | Ishii, Wataru
Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. The World Society of Emergency Surgery (WSES) has designed the CIAOW study in order to describe the clinical, microbiological, and management-related profiles of both community- and healthcare-acquired complicated intra-abdominal infections in a worldwide context. The CIAOW study (Complicated Intra-Abdominal infection Observational Worldwide Study) is a multicenter observational study currently underway in 57 medical institutions worldwide. The study includes patients undergoing surgery or interventional drainage to address complicated intra-abdominal infections. This preliminary report includes all data from almost the first two months of the six-month study period. Patients who met inclusion criteria with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 702 patients with a mean age of 49.2 years (range 18–98) were enrolled in the study. 272 patients (38.7%) were women and 430 (62.3%) were men. Among these patients, 615 (87.6%) were affected by community-acquired IAIs while the remaining 87 (12.4%) suffered from healthcare-associated infections. Generalized peritonitis was observed in 304 patients (43.3%), whereas localized peritonitis or abscesses was registered in 398 (57.7%) patients.
The overall mortality rate was 10.1% (71/702). The final results of the CIAOW Study will be published following the conclusion of the study period in March 2013.
doi:10.1186/1749-7922-8-1
PMCID: PMC3538624  PMID: 23286785
10.  Is close monitoring in the intensive care unit necessary after elective liver resection? 
Purpose
Many surgical patients are admitted to the intensive care unit (ICU), resulting in an increased demand, and possible waste, of resources. Patients who undergo liver resection are also transferred postoperatively to the ICU. However, this may not be necessary in all cases. This study was designed to assess the necessity of ICU admission.
Methods
The medical records of 313 patients who underwent liver resections, as performed by a single surgeon from March 2000 to December 2010 were retrospectively reviewed.
Results
Among 313 patients, 168 patients (53.7%) were treated in the ICU. 148 patients (88.1%) received only observation during the ICU care. The ICU re-admission and intensive medical treatment significantly correlated with major liver resection (odds ratio [OR], 6.481; P = 0.011), and intraoperative transfusions (OR, 7.108; P = 0.016). Patients who underwent major liver resection and intraoperative transfusion were significantly associated with need for mechanical ventilator care, longer postoperative stays in the ICU and the hospital, and hospital mortality.
Conclusion
Most patients admitted to the ICU after major liver resection just received close monitoring. Even though patients underwent major liver resection, patients without receipt of intraoperative transfusion could be sent to the general ward. Duration of ICU/hospital stay, ventilator care and mortality significantly correlated with major liver resection and intraoperative transfusion. Major liver resection and receipt of intraoperative transfusions should be considered indicators for ICU admission.
doi:10.4174/jkss.2012.83.3.155
PMCID: PMC3433552  PMID: 22977762
Hepatectomy; Major resection; Intensive care units; Intraoperative transfusion
11.  Long-term Follow-up of Laparoscopic Splenectomy in Patients with Immune Thrombocytopenic Purpura 
Journal of Korean Medical Science  2007;22(3):420-424.
Laparoscopic splenectomy (LS) has been reserved for intractable and relapsing immune thrombocytopenic purpura (ITP) despite medical treatment. With further experiences of LS in ITP, we investigated long term outcomes of LS, especially newly developed morbidities, and tried to find predictive factors for favorable outcomes. From August 1994 to December 2004, fifty-nine patients whose follow-up period was more than 12 months after LS were investigated. After a long-term follow-up (median 54 months, range 12.5-129 months), a complete response (CR) was found in 28 patients (47.5%), partial response in 24 (40.7%), and no response in 7 (11.9%). The relapse rate during follow-up periods was 15.2%. The rapid response group (p=0.017), in which the platelet count increased more than twice of the preoperative platelet count within 7 days after LS, relapsing after medical treatment (p=0.02), and the satisfactory group as the initial result of LS (p=0.001) were significant for predicting CR in univariate analysis, but only the initial satisfactory group was an independent predictive factor for CR in multivariate analysis (p=0.036, relative risk=6419; 95% CI, 1.171-35.190). Infections were the most frequent morbidities during the follow-up period, which were treated well without mortality. LS is a safe and effective treatment modality for ITP. Active referral to surgery might be required, considering complications and treatment results related to long-term use of steroid-based medications.
doi:10.3346/jkms.2007.22.3.420
PMCID: PMC2693631  PMID: 17596647
Laparoscopic Splenectomy (LS); Immune Thrombocytopenic Purpura (ITP); Follow-up
12.  Inflammatory Pseudotumor of the Liver Treated by Hepatic Resection: A Case Report 
Yonsei Medical Journal  2006;47(1):140-143.
Inflammatory pseudotumor (IPT) of the liver is rare benign tumor. When the diagnosis of IPT is established with biopsy, simple observation or conservative therapy is preferred because of the possibility of regression. But IPT is unresponsive to the conservative treatment, surgical resection should be considered. We experienced a 63-year-old male, who was suspected hepatocellular carcinoma in abdominal computed tomography (CT) and magnetic resonance image (MRI) scan, presented with 2-month history of intermittent fever and weight loss. Percutaneous ultrasound guided core biopsy confirmed IPT of the liver. Non-steroidal anti-inflammatory drugs and antibiotics were administered for 8 and 4 weeks, respectively, but fever continued. So, extended right hepatectomy was performed for IPT of the liver and then fever subsided. The patient remains well during a follow-up period of 12 months.
doi:10.3349/ymj.2006.47.1.140
PMCID: PMC2687572  PMID: 16502497
Inflammatory pseudotumor; liver; hepatic resection
13.  The Actual Five-year Survival Rate of Hepatocellular Carcinoma Patients after Curative Resection 
Yonsei Medical Journal  2006;47(1):105-112.
The five-year survival rate of patients after curative resection of hepatocellular carcinoma (HCC) has been reported to be 30 to 50%, however the actual survival rate may be different. We analyzed the actual 5-year survival rate and prognostic factors after curative resection of HCC. Retrospective analysis was performed on 63 HCC patients who underwent curative resection from 1998 to 1999. A total of 63 cases were reviewed, consisting of 53 men and 10 women, with a median age of 49 years. These cases included all four pathologic T stages (pT stage) and had the following representation: stage 1 (1 case), stage 2 (17 cases), stage 3 (38 cases), and stage 4 (7 cases). In our study, the actual 5-year survival rate was 57.0% and the median survival time was 60 months. In addition, the patients in our study had an actual 5-year disease-free survival rate of 50.2% and a median disease-free survival time of 46 months. Thirty-one patients had recurrences, with a majority occurring within one year (65%). These patients with early recurrences had a poor actual 5-year survival rate of 5%. A univariate analysis showed that the prognostic factors influencing survival rate were the presence of satellite nodules, increased pT stage, HCC recurrence, and the time to recurrence (within one year). Interestingly, microvascular invasion made a difference in survival rate but was not statistically significant (p = 0.08). Furthermore, factors influencing the disease free survival rate include the presence of satellite nodules, microvascular invasion, and pT stage. Multivariate analysis identified pT stage as the only statistically related factor in determining the disease-free survival rate. The most important prognostic factor of HCC is recurrence. Moreover, the major risk factor for recurrence is an advanced pT stage. Therefore, performing prospective studies of postoperative adjuvant therapy is necessary to prevent recurrences after hepatic resection. Furthermore, active preventative treatment and early diagnosis of recurrences should be of the highest priority in the care of high-risk patient groups that have an advanced pT stage.
doi:10.3349/ymj.2006.47.1.105
PMCID: PMC2687566  PMID: 16502491
Hepatocellular carcinoma; hepatic resection; five-year survival rate
14.  Characterization of a Highly Pathogenic H5N1 Avian Influenza A Virus Isolated from Duck Meat 
Journal of Virology  2002;76(12):6344-6355.
Since the 1997 H5N1 influenza virus outbreak in humans and poultry in Hong Kong, the emergence of closely related viruses in poultry has raised concerns that additional zoonotic transmissions of influenza viruses from poultry to humans may occur. In May 2001, an avian H5N1 influenza A virus was isolated from duck meat that had been imported to South Korea from China. Phylogenetic analysis of the hemagglutinin (HA) gene of A/Duck/Anyang/AVL-1/01 showed that the virus clustered with the H5 Goose/Guandong/1/96 lineage and 1997 Hong Kong human isolates and possessed an HA cleavage site sequence identical to these isolates. Following intravenous or intranasal inoculation, this virus was highly pathogenic and replicated to high titers in chickens. The pathogenesis of DK/Anyang/AVL-1/01 virus in Pekin ducks was further characterized and compared with a recent H5N1 isolate, A/Chicken/Hong Kong/317.5/01, and an H5N1 1997 chicken isolate, A/Chicken/Hong Kong/220/97. Although no clinical signs of disease were observed in H5N1 virus-inoculated ducks, infectious virus could be detected in lung tissue, cloacal, and oropharyngeal swabs. The DK/Anyang/AVL-1/01 virus was unique among the H5N1 isolates in that infectious virus and viral antigen could also be detected in muscle and brain tissue of ducks. The pathogenesis of DK/Anyang/AVL-1/01 virus was characterized in BALB/c mice and compared with the other H5N1 isolates. All viruses replicated in mice, but in contrast to the highly lethal CK/HK/220/97 virus, DK/Anyang/AVL-1/01 and CK/HK/317.5/01 viruses remained localized to the respiratory tract. DK/Anyang/AVL-1/01 virus caused weight loss and resulted in 22 to 33% mortality, whereas CK/HK/317.5/01-infected mice exhibited no morbidity or mortality. The isolation of a highly pathogenic H5N1 influenza virus from poultry indicates that such viruses are still circulating in China and may present a risk for transmission of the virus to humans.
doi:10.1128/JVI.76.12.6344-6355.2002
PMCID: PMC136198  PMID: 12021367

Results 1-14 (14)