• Annals of Surgical Treatment and Research
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• v.95 no.5
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• pp.258-266
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• 2018

Purpose: This study analyzes the impact of laparoscopic liver resection on intra-abdominal adhesion. Methods: Patients who underwent salvage liver transplantation after liver resection for hepatocellular carcinoma from January 2012 to October 2017 at our institution were included. Information about the severity of intra-abdominal adhesions was collected from a prospectively maintained database. Intra-abdominal adhesions were graded after the agreement of 2 surgeons who participated in the salvage liver transplantation based on predetermined criteria. Adhesion severity and demographic, operative, and postoperative data were compared between the laparoscopic group and the open group. Multivariate logistic regression was performed to consider potential factors related to severe adhesion during salvage transplantation. Results: Sixty-two patients who underwent salvage liver transplantation after liver resection were included in this study. Among them, 52 patients underwent open surgery, and 10 patients underwent laparoscopy. Adhesion was significantly more severe in the open group than in the laparoscopy group (P = 0.029). A multivariate logistic regression model including potential factors related to severe adhesion showed that laparoscopy (odds ratio, 0.168; 95% confidence interval, 0.029-0.970; P = 0.048) was the only significant factor. Conclusion: Laparoscopic liver resection for hepatocellular carcinoma can minimize intra-abdominal adhesion during salvage liver transplantation.

• Annals of Surgical Treatment and Research
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• v.95 no.6
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• pp.340-344
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• 2018

Purpose: Traumatic lumbar hernia is rare, thus making diagnosis and proper treatment challenging. Accordingly, we aimed to investigate the clinical manifestations and proper management strategies of traumatic lumbar hernias. Methods: The medical records of patients with traumatic lumbar hernia treated at Gachon University Gil Hospital from March 2006 to February 2015, were retrospectively reviewed. Results: We included 5 men and 4 women (mean age, 55 years; range, 23-71 years). In 8 patients, most injuries were caused by motor vehicle collisions, including those wherein a pedestrian was struck (5 cases of car accidents, 2 falls, and 1 involving penetrating materials); in 1 patient, the probable cause was severe cough. Eight patients underwent hernia repair surgery (5 open and 3 laparoscopic), and a prosthetic mesh was used in 7 patients. Hernia repairs were elective in 7 patients; emergency hernia repair was performed with right hemicolectomy in 1 patient. No severe complication or recurrence was observed. Only 2 patients had mild complications, such as postoperative seroma. Conclusion: Traumatic lumbar hernia is a relatively rare injury of the posteriolateral abdominal wall. Lumbar hernia should be suspected in patients with high-energy injuries of the torso, and all such patients should undergo abdominopelvic computed tomography. After diagnosis, hernia repair can be electively performed without complications in most cases.

• Annals of Surgical Treatment and Research
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• v.96 no.2
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• pp.78-85
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• 2019

Purpose: Insistence that total regression of primary tumor would not represent long-term oncologic outcomes has been raised. Therefore, this study aimed to evaluate the outcomes of these patients after preoperative chemoradiotherapy (PCRT) and radical surgery and to evaluate the associated risk factors. Methods: We included 189 patients with rectal cancer who showed total regression of the primary tumor after PCRT, followed by radical resection, between 2001 and 2012. Recurrence-free survival (RFS) was calculated using the Kaplan-Meier method, and the results were compared with 77 patients with Tis rectal cancer who received only radical resection. Factors associated with RFS were evaluated using Cox regression analysis. Results: Sphincter-saving resection was performed for 146 patients (77.2%). Adjuvant chemotherapy was administered to 168 patients (88.9%). During the follow-up period, recurrence occurred in 17 patients (9%). The 5-year RFS was 91.3%, which was significantly lower than that of patients with Tis rectal cancer without PCRT (P = 0.005). In univariate analysis, preoperative CEA and histologic differentiation were associated with RFS. However, no factors were found to be associated with RFS. Conclusion: RFS was lower in patients with total regression of primary rectal cancer after PCRT than in those with Tis rectal cancer without PCRT, and it would not be considered as the same entity with early rectal cancer or "disappeared tumor" status.

• Proceedings of the Korea Water Resources Association Conference
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• 2019.05a
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• pp.8-8
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• 2019

전 세계적으로 ASR, ASTR과 같은 인공함양에 대한 연구가 활발히 진행되고 있다. 본 연구에서는 수자원을 확보하고 생산수의 수질 개선을 꾀할 수 있는 지하 저수지 기술을 개발하고 낙동강 하구의 염 대수층에 설치한 시험시설에서 검증하였다. 국내외 대 하천의 하구에는 상부에는 점토층이 발달해 있고 하부에는 대수층이 대규모로 발달해 있으나 염 지하수로 포화되어 있는 경우가 많다. 점토층은 오염된 지표수나 지표면에서 발생한 오염사고로부터 하부의 피압 대수층을 분리하는 역할을 할 수 있다. 따라서 피압 대수층은 기존의 지표수 수자원 또는 대체 수자원의 한계를 극복할 수 있는 좋은 수자원 확보 공간이 될 수 있다. 지하 저수지 실증 연구를 위하여 낙동강 하구의 피압 대수층에 주입정, 양수정과 관측정 등을 포함한 시험 시설을 설치하였다. 낙동강에서 취수한 지표수의 부유물을 제거하고 대수층에 주입하여 기존의 염 지하수를 밀어내고 렌즈 형태의 담수체 (지하 저수지)를 조성하였다. 양수정과 관측정을 통하여 조사된 지하 저수지는 원 지하수가 배제되었고, 하천수보다 수질이 개선되었음을 보였다. 본 고에서는 실증 연구에서 도출된 수자원 확보 및 수질 개선 성과를 제시하고자 한다. 지하 저수지는 공사 규모가 작고, 수몰지가 발생하지 않으며, 수요지 인근에 위치해 있어 지역 내 수자원 자급이 가능하고, 토지 이용도 자유롭다. 또한 평상 시에 연중 균일한 양질의 수자원 공급이 가능하고 가뭄, 지표수 오염 등 비상 시에도 장기간 안정적으로 청정 수자원 공급이 가능하다. 지하 저수지는 물 안보도 제고를 위한 취수원 다변화 차원에서 기여할 수 있을 것으로 판단된다.

• Proceedings of the Korea Water Resources Association Conference
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• 2015.05a
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• pp.244-244
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• 2015

Managed Aquifer Recharge (MAR) in the form of Aquifer Storage and Recovery (ASR) systems are being applied for numerous water augmentation projects both in developed and developing countries. Given the onset of Climate Change and its influence on weather patterns and land use, it has been acknowledged the utilization of this technology will be ever increasing. This technique like all others does have its drawbacks or disadvantages, whereby to overcome these drawbacks or disadvantages it is recommended that logical planning process be followed. In this study, we developed a decision framework known as "Decision framework for the planning, designing, construction/testing and implementation of subsurface water storage system" to further standardize the planning and design process of subsurface water storage system to increase the probability of having a successful ASR/ASTR project. The formulation of this framework was based on earlier frameworks, guidelines, published papers and technical reports which were compiled into a data collection database. The database of which consider both qualitative and quantitative aspect for example recharge objectives, site location, water chemistry of the native, source and recovered water, aquifer characteristics(hydraulic conductivity, transmissivity, porosity), injection/pumping rate, ecological constraints, societal restrictions, regulatory restrictions etc. The assimilation of these factors into a singular framework will benefit the broad spectrum of stakeholder as it maps the chronological order under which ASR project should be undertaken highlighting at each stage the feasibility of the project. The final stage of which should result in fully operational ASR system. The framework was applied to two case studies and through the application of a modified ASR site selection suitability index (Brown et al., 2005) a score was derived to identify the performance of each site. A high score of which meant a maximize chance of success given the reduce presence of project constraints.

• Annals of Surgical Treatment and Research
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• v.95 no.6
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• pp.312-318
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• 2018

Purpose: Acute normovolemic hemodilution (ANH) is an autologous transfusion method, using blood collected during surgery, to reduce the need for allogeneic blood transfusion. ANH is controversial because it may lead to various complications. Among the possible complications, anastomotic leakage is one that would have a significant effect on the operation outcome. However, the relationship between ANH and anastomotic site healing requires additional research. Therefore, we conducted this prospective study of ANH, comparing it with standard intraoperative management, undergoing gastric anastomosis in rats. Methods: Sixteen Sprague-Dawley rats were randomly assigned to three groups: group A, surgery with ANH; group N, surgery with standard intraoperative management; and group C, sham surgery with standard intraoperative management. ANH was performed in group A animals by, removing 5.8-6.6 mL of blood and replacing it with 3 times as much crystalloid. All rats were enthanized on postoperative day 6, and histopathologic analyses were performed. Results: The mean hematocrit values, after hemodilution were 22.0% (range, 18.0%-29.0%), group A; 33.0% (29.0%-35.0%), group N; and 32.5% (29.0%-34.0%), group C. There were significant differences between groups A and N (P = 0.019, P = 0.009, P = 0.004, P = 0.039, and P = 0.027), and between groups N and C (P = 0.006, P = 0.027, P = 0.04, P = 0.008, and P = 0.009) with respect to inflammatory cell numbers, neovascularization, fibroblast numbers, edema and necrosis, respectively; there were no differences between groups A and N. Conclusion: In rat model, anastomotic complications did not increase in the ANH group, compared with the standard intraoperative management group.

• Annals of Surgical Treatment and Research
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• v.95 no.5
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• pp.267-277
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• 2018

Purpose: The aim of this study was to analyze survival outcomes in 1,000 consecutive liver transplantations (LTs) performed at a single institution from 1993 to April 2017. Methods: The study population was divided into 2 groups based on donor type: deceased donor LT (DDLT; n = 181, 18.1%) and living donor LT (LDLT; n = 819; 81.9%), and into 3 periods based on the number of cases (first 300 cases, middle 300 cases, last 400 cases). Results: Infection was the most common cause of death, accounting for 34.8% (95 of 273). Mortality due to hepatocellular carcinoma recurrence occurred most frequently between 1 and 5 years after transplantation. Mortality rate by graft rejection was highest between 5 and 10 years after transplantation. And mortality by de novo malignancy occurred most frequently after 10 years after transplantation. The patient survival rates for the entire population at 5 and 10 years were 74.7%, and 68.6%, respectively. There was no difference in survival rate between the LDLT and DDLT groups (P = 0.188). Cause of disease, disease severity, case period, and retransplantation had a significant association with patient survival (P = 0.002, P = 0.031, P = 0.003, and P = 0.024, respectively). Conclusion: Surgical techniques and perioperative management for transplant patients have improved and undergone standardization. Controlling perioperative infection and managing patients with HCC as LT candidates will result in better outcomes.

• Annals of Surgical Treatment and Research
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• v.95 no.6
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• pp.319-323
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• 2018

Purpose: Currently, many operations are performed using the single-incision laparoscopic method. Although there have been recent reports on single-incision laparoscopic ileostomy, none have compared this method to conventional laparoscopic ileostomy. This study aimed to assess the safety and feasibility of single-incision laparoscopic ileostomy for anastomotic leakage following laparoscopic low anterior resections. Methods: From April 2012 to April 2017, 38 patients underwent laparoscopic ileostomy (single-incision; 19 patients referred to as group A, conventional laparoscopy; 19 patients referred to as group B) for anastomotic leakage following laparoscopic low anterior resection. We analyzed surgical and clinical outcomes between the 2 groups. Patients in whom a protective ileostomy was carried out during the initial laparoscopic low anterior resection were excluded from this study. Results: No significant differences were observed between the 2 groups in terms of patient demographics and initial operation details. Incisional surgical site infections occurred less in group A than in group B (2 of 19 vs. 9 of 19, P = 0.029). The median ileostomy operation time, amount of intraoperative bleeding, parastomal hernia ratio, hospital stay duration after ileostomy, postoperative pain score were not significantly different between the 2 groups. Conclusion: Single-incision laparoscopic ileostomy is safe and feasible method of fecal diversion for anastomotic leakage following laparoscopic low anterior resection.

• Annals of Surgical Treatment and Research
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• v.95 no.5
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• pp.233-239
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• 2018

Purpose: In Korea, the working-hour limitation regulation has been implemented in December 2017. We aimed to define the difference in operative experience of surgical residents before and after implementing this policy in 2 hospitals among 8 affiliated hospitals of the Catholic Medical Center where implemented the 80 working-hour limitation policy since March 2015. Methods: All the operation records were reviewed, and the number of resident-participated surgeries between March and August in 2002 and 2017 were compared. Operations performed or participated in by residents as first assistants were defined as resident participated surgery. Results: After 2 years from the initiation of the resident work-hour limitations, the number of resident participated surgery has slightly decreased in both hospitals (Yeouido St. Mary's Hospital [YSM]: 317 to 302, St. Paul Hospital [SPH]: 635 to 461). For each resident, changes were like followings: $0{\rightarrow}21$ cases for R1, $65{\rightarrow}72$ cases for R2, $83{\rightarrow}192$ cases for R3, and $169{\rightarrow}17$ cases for R4 in YSM. In SPH, number of resident participating surgery was changed like followings: $4{\rightarrow}32$ cases for R1, $222{\rightarrow}100$ cases for R2, $317{\rightarrow}300$ cases for R3, and $92{\rightarrow}29$ cases for R4. In both hospital, while, total number of resident participating oncologic surgery has been decreased, number of resident participating appendectomy has been far increased. Activity of each grade resident is different according to hospital. Conclusion: Although total number of resident participating surgery decreased, variable changes were observed in each grade of resident according to each type of surgery and different hospitals. It is believed that comparisons of experiences from more hospitals in the future would be helpful in establishing the guidelines for surgical experience requirement of residents in Korea.

• Annals of Surgical Treatment and Research
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• v.95 no.5
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• pp.240-248
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• 2018

Purpose: This study aimed to validate the synergistic effect of ABT-737 on docetaxel using MDA-MB-231, a triple negative breast cancer (TNBC) cell line overexpressing B-cell lymphoma-2 (Bcl-2). Methods: Western blot analysis was performed to assess expression levels of Bcl-2 family proteins and caspase-related molecules. Cell viability was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Cell cycle distribution was determined by flow cytometry analysis. Benzyloxycarbonyl-Val-Ala-Asp(OMe)-fluoromethylketone (z-VAD-fmk) was used for pretreatment to assess the role of caspases. Results: Cell viability of MDA-MB-231 after combination treatment with ABT-737 and docetaxel was significantly lower than that after docetaxel or ABT-737 monotherapy based on MTT assay (both P < 0.001), with a combination index of 0.41. The proportion of sub-G1 population after combination treatment was significantly higher than that after docetaxel or ABT-737 monotherapy (P = 0.001, P = 0.003, respectively). Pretreatment with z-VAD-fmk completely restored cell viability of MDA-MB-231 from apoptotic cell death induced by combination therapy (P = 0.001). Although pro-caspase-8 or Bid did not show significant change in expression level, pro-casepase-9 showed significantly decreased expression after combination treatment. Cleaved caspase-3 showed increased expression while poly (ADP-ribose) polymerase cleavage was induced after combination treatment. However, hypoxia-inducible factor 1-alpha and aldehyde dehydrogenase 1 totally lost their expression after combination treatment. Conclusion: Combination of ABT-737 with docetaxel elicits synergistic therapeutic effect on MDA-MB-231, a TNBC cell line overexpressing Bcl-2, mainly by activating the intrinsic pathway of apoptosis. Therefore, adjunct of ABT-737 to docetaxel might be a new therapeutic option to overcome docetaxel resistance of TNBCs overexpressing Bcl-2.