Laparoscopic Gastrectomy Performed by an Expert in Open Gastrectomy

Chi, Kyong-Choun,Park, Joong-Min The Korean Gastric Cancer Association 2017 Journal of gastric cancer Vol.17 No.3

Purpose: Senior surgeons prefer open gastrectomy (OG), while young surgeons prefer laparoscopic gastrectomy (LG). The purpose of this study was to evaluate the surgical outcomes of LG performed by a senior surgeon who was an expert in OG during his learning period, by comparing them with LGs performed by a young surgeon. Materials and Methods: A senior surgeon performed 50 curative gastrectomies with laparoscopy (LG-S group) from March 2015 to August 2016. A young surgeon's initial 50 LGs comprised the LG-Y group. Clinicopathological characteristics and surgical outcomes were compared between the LG-S and LG-Y groups. Results: D2 lymphadenectomy was more frequently performed in the LG-S group than in the LG-Y group (P=0.029). The operation time and number of retrieved lymph nodes did not significantly differ between the 2 surgeons (P=0.258 and P=0.410, respectively). Postoperative hospital stay and postoperative complication rate were similar between 2 groups (P=0.234 and P=1.000, respectively). Similarly, significant decreases in operation time with increasing case numbers were observed for both surgeons, whereas the number of retrieved lymph nodes increased significantly in the LG-Y group but not in the LG-S group. Conclusions: The LG outcomes when performed by the senior surgeon were comparable to those when performed by the young surgeon, despite performing more extended lymphadenectomies. Senior surgeons who are experts in OG should not refrain from performing LG.

복부 외상에 관한 임상적 고찰

지경천(Kyong Choun Chi),임현묵(Hyun Muck Lim),장선택(Sun Taik Chang) 대한외과학회 1986 Annals of Surgical Treatment and Research Vol.31 No.5

허혈-재관류에 의한 흰쥐 간의 손상에 있어서 반응성 산소종의 역할

지경천,권년수,이희성,김상준,장선택 중앙대학교 의과대학 의과학연구소 1992 中央醫大誌 Vol.17 No.4

Increased generation of reactive oxygen species is thought to be a major cause of tissue in ischemia-reperfusion injury. Left and median lobes of rat livers were subjected to 20 minutes of ischemia followed by reperfusion for up to 120 minutes. Superoxide radical generation was enhanced to 338 μmol/minute/g tissue after 60 minutes of reperfusion,and 367 μmol/minute/g tissue after 120 minutes. Superoxide generation in the liver of the control animal was 260 μmol/minute/g tissue. The activity of xanthine oxidase, a superoxide radical-generating enzyme, was also elevated in the liver treated with ischemia-referfusion. These results indicate that xanthine oxidase-catalyzed reaction is an important source for the superoxide generation in rat liver treated with ischmia-referfusion. The activities of superoxide dismutase and catalase, enzyme responsible in removing superoxide radical and hydrogen peroxide, were measured. Cu, Zn-superoxide dismutase activity was significantly higher in reperfused liver after ischemia than in control. However, the activity of Mn-containing superoxide dismutase was significantly low in reperfusion. The extent of tissue damage by ischemia-reperfusion was evaluated by measuring lipid peroxidation. Thiobarbituric acid reactive substance was significantly elevated in the liver treated with 60 minutes of ischemia followed by 60 minute of reperfusion. These results suggested that increased reactive oxygen species and diminished activities of enzyme removing toxic oxygen species rendered the damages on the liver which was sujected to ischemia followed by reperfusion.

외과 영역의 감염증에 대한 Ceotetan (YM 09330)의 임상효과

지경천,박성일,장선택 중앙대부설한국의과학연구소 1985 한국의과학 Vol.17 No.4

범발성 혈관내 응혈증

지경천,임현묵,장선택 중앙대부설한국의과학연구소 1983 한국의과학 Vol.15 No.4

원발성 담낭암에 대한 임상적 고찰

지경천,임현묵,박성일,장선택 중앙대부설한국의과학연구소 1985 한국의과학 Vol.17 No.4

Long-limb Roux-en-Y Reconstruction after Subtotal Gastrectomy to Treat Severe Diabetic Gastroparesis

박중민,Jong Won Kim,Kyong-Choun Chi 대한위암학회 2019 Journal of gastric cancer Vol.19 No.3

The role of surgical intervention in patients with diabetic gastroparesis is unclear. We reporta case of a 37-year-old man with a history of recurrent episodes of vomiting and long-standingtype 2 diabetes mellitus. Esophagogastroduodenoscopy did not reveal any findings of refluxesophagitis or obstructive lesions. A gastric emptying time scan showed prolonged gastricemptying half-time (344 minutes) indicating delayed gastric emptying. Laboratory testsrevealed elevated fasting serum glucose and glycosylated hemoglobin (HbA1c, 12.9%) andnormal fasting C-peptide and insulin levels. We performed Roux-en-Y reconstruction aftersubtotal gastrectomy to treat gastroparesis and improve glycemic control, and the patientshowed complete resolution of gastrointestinal symptoms postoperatively. Barium swallowtest and gastric emptying time scan performed at follow-up revealed regular progressionof barium and normal gastric emptying. Three months postoperatively, his fasting serumglucose level was within normal limits without the administration of insulin or oralantidiabetic drugs with a reduced HbA1c level (6.9%). Long-limb Roux-en-Y reconstructionafter subtotal gastrectomy may be useful to treat severe diabetic gastroparesis by improvinggastric emptying and glycemic control.

장중첩증 136예에 대한 임상적 고찰

장인택,지경천,장선택 중앙대부설한국의과학연구소 1983 한국의과학 Vol.15 No.2

Antireflux surgery is equally beneficial in nonerosive and erosive gastroesophageal reflux disease

Joong-Min Park,Kyong-Choun Chi 대한외과학회 2018 Annals of Surgical Treatment and Research(ASRT) Vol.95 No.2

Purpose: Although nonerosive and erosive gastroesophageal reflux disease (GERD) have similar symptom severity, nonerosive reflux disease (NERD) is considered a milder type of GERD and gastroenterologists have hesitated to refer these patients for antireflux surgery. The aim of this study was to compare surgical outcomes of antireflux surgery between patients with NERD and erosive reflux disease (ERD). Methods: Seventy patients met the inclusion criteria of this study among a total of 117 patients who underwent antireflux surgery from November 2012 to October 2017. According to preoperative endoscopy, patients were classified into NERD group (minimal changes or no esophagitis) and ERD group. Clinical characteristics and surgical outcomes were compared between NERD and ERD. Results: There were 26 patients in NERD group and 44 patients in ERD group. The male:female ratio was higher in the ERD group than in the NERD group (P = 0.044). Preoperative symptoms, response to acid suppressive medication, acid exposure on pH monitoring study, and esophageal manometry results were similar in the 2 groups. Reflux on barium esophagography was more frequently observed in ERD (77.3%) than in NERD (50.0%, P = 0.019). At 6 months after surgery, complete resolution and partial improvement of GERD symptoms were similar in the 2 groups (80.8% and 15.4%, respectively, in NERD vs. 88.6% and 2.3%, respectively, in ERD; P = 0.363). Conclusion: Laparoscopic Nissen fundoplication is equally beneficial to patients with NERD and ERD. Antireflux surgery should not be avoided for GERD patients without mucosal breaks on endoscopy as the evidence of erosive esophagitis.

Laparoscopic reversal of Hartmann’s procedure

Joong-Min Park,Kyong-Choun Chi 대한외과학회 2012 Annals of Surgical Treatment and Research(ASRT) Vol.82 No.4

Reversal of Hartmann’s procedure is a major surgical procedure associated with significant morbidity and mortality. Because of the difficulty of the procedure, laparoscopic reversal of Hartmann’s procedure is not well established. We describe our experience with this laparoscopic procedure to assess its difficulty and safety. Five patients (4 men and 1 woman) underwent laparoscopic reversal of Hartmann’s procedure (LRHP). The initial surgeries were performed to manage obstructive colorectal cancer for 4 patients, and rectovesical fistula for one patient. The procedure was laparoscopically completed for 4 patients. Conversion to open laparotomy was required for one patient, secondary to massive adhesion in lower abdomen. Transient ileostomies were made in 2 cases. Operative time ranged from 240 to 545 minutes. There was no operative mortality. LRHP can be performed safely by an experienced surgeon. However, it is still technically challenging and time consuming.