• Journal of Korean Neurosurgical Society
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• 제30권2호
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• pp.150-155
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• 2001

Between January 1995 and May 1998, 177 patients with proven lumbar disc herniation were treated by microdiscectomy or by percutaneous endoscopic discectomy(PED). Among them, 43(24.2%) patients underwent PED and were followed for long term outcome. We included only those patients who were followed up more than 13 months. Three patients who did not improved immediately after PED and underwent microdiscectomy were excluded for this study. Of remaining 40 patients, there were 22 men and 18 women who ranged in age from 23 to 68 years (mean 38.1 years). The disc herniations were located at L1-2(1), L2-3(1), L3-4(1), L4-5(26) and L5-S1(11). Three patients were treated by biportal approach. The mean follow up period was 34.7 months(range 13-47 months). Overall, excellent and good results were achieved in 12(30%) and 19(47.5%) patients, and fair and poor results in 7(17.5%) and 2(5%) patients, respectively. Thirty-eight(95%) patients returned to their previous works and the mean duration was 5.7 months. Thirty-three(82.5%) patients answered that they would recommend this procedure to others. There was no complication except for one patient who suffered from discitis. The indication of PED is restricted to contained or small subligamentous lumbar disc herniation without stenosis, spondylolisthesis and sequestration. PED can be performed under local anesthesia and tissue trauma, risk of epidural scarring, hospitalization time and postoperative morbidity are minimal. The result of the present study justify the assumption that PED can be a surgical alternative for patients suitable for its indications.

• Journal of Digestive Cancer Research
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• 제11권2호
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• pp.99-103
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• 2023

Malignant tumors located near the papilla of the duodenum can cause concomitant biliary and duodenal obstruction, which reduces the quality of life and increases the morbidity and mortality. Apart from traditional surgical treatment methods, various treatment methods such as endoscopic treatment and radiological interventions are used for the treatment. This study aimed to explore treatment methods according to the situation of patients with malignant biliary obstruction combined with duodenal obstruction.

• 대한후두음성언어의학회지
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• 제19권1호
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• pp.31-37
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• 2008

Patients with impaired ability to eat require nutritional support enterally or parenterally. Gastrostomy is a preferred method because total parenteral nutrition has many complications and high cost. Surgical gastrostomy has been a traditional and well-established method prior to the development of percutaneous gastrostomy. Since then, percutaneous gastrostomy has been established as an effective, safe, easy technique with a low morbidity and mortality rate. Consequently, percutaneous gastrostomy has been the first method for long-term enteral nutrition. The purpose of this review is to describe the techniques, indications, complications of percutaneous radiologic gastrostomy/gastrojejunostomy and to compare with endoscopic method.

• Journal of Korean Neurosurgical Society
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• 제41권4호
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• pp.241-245
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• 2007

Objective : So called "minimally invasive procedures" have evolved from chemonucleolysis, automated percutaneous discectomy, arthroscopic microdiscectomy that are mainly working within the confines of intradiscal space to transforaminal endoscopic technique to remove herniated epidural disc materials directly. The purpose of this study is to assess the result of endoscopic spinal surgery and favorable indication in the thoracolumbar spine. Methods : The records of 71 patients, 73 endoscopic procedures, were retrospectively analysed. Yeung Endoscopic Spine Surgery system with 7 mm working sleeve and $25^{\circ}$ viewing angle was used. The mean follow up period was 6 months [range, 3-9]. Results : Operated levels were from T12-L1 disc down to L5-L6 of S1 disc. Of 71 cases, 2 patients underwent transforaminal endoscopic surgery twice due to recurrence after initial operation. MacNab's criteria was used to assess the outcome. Favorable outcome, excellent of good, was seen in 78% [57 procedures] of the patients. Among 11 fair outcomes, only 1 procedure was followed by secondary open procedure, laminectomy with discectomy. Two of 5 poor outcomes were operated again by same procedure which resulted in fair outcomes. One patient with aggravated cauda equina syndrome remained poor and a lumbar fusion procedure was performed in other patient with poor outcome. There were 2 postoperative discitis that were treated with conservative care in one and anterior lumbar interbody fusion in the other. Conclusion : Evolving technology of mechanical, visual instrument enables minimal invasive procedure possible and effective. The transforaminal endoscopic spinal surgery can reach as high as T12-L1 disc level. The rate of favorable outcome is mid-range among reported endoscopic lumbar surgery series. Authors believe that the outcome will be better as cases accumulate and will be able to reach the fate of standard open microsurgery.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제17권4호
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• pp.214-222
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• 2014

Purpose: The method of percutaneous endoscopic gastrostomy (PEG) tube placement can be divided into the pull and introducer techniques. We compared short-term complications and prognosis between patients who underwent the pull technique and two other types of introducer techniques, the trocar introducer technique and T-fastener gastropexy technique. Methods: Twenty-six patients who underwent PEG were enrolled in this study. We retrospectively investigated the age, sex, body weight, weight-for-age Z-score, underlying diseases, PEG indications, complications, duration of NPO (nil per os), pain control frequency, and duration of antibiotic therapy. The patients were classified into three groups according to the PEG technique. The occurrence of complications was monitored for 10 weeks after the procedure. Results: The age, sex, body weight, and weight-for-age Z-score were not significantly between the three groups. Most patients had cerebral palsy and seizure disorders. Dysphagia was the most common indication for PEG. Major complications occurred in 5 (50%), 4 (66.7%), and 0 (0%) patients in group I, II, and III, respectively (p=0.005). Further, peristomal infection requiring systemic antibiotic therapy occurred in 2 (20%), 3 (50%), and 0 (0%) patients in group I, II, and III, respectively (p=0.04). There was no significant difference between the groups with respect to minor complications, duration of NPO, pain control frequency, and duration of antibiotic therapy. Conclusion: The results indicate that the T-fastener gastropexy technique was associated with the lowest rate of major complications.

• 대한영상의학회지
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• 제83권1호
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• pp.224-229
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• 2022

담관 원주 증후군은 간이식을 받은 환자들에게서 발생하는 흔치 않은 합병증이다. 간이식을 받은 환자의 약 5%-18%에서 발생한다. 간이식을 받지 않은 환자에게서 드물게 담관 원주 증후군이 발생하는 것으로 보고되었다. 이식 후 담관 손상, 허혈, 담도 감염, 수술 후 거치된 담도 배액관 등이 병리요인으로 제안되었으나 담도 원주의 병리현상은 아직 명확히 규명되지 않았다. 이에 저자들은 간이식을 받지 않은 49세 남성에게서 총담관 결석에 대해 내시경과 경피적 담관 조영 시술 후에 발생된 담관 원주 증후군의 사례를 소개한다.

• The Korean Journal of Pain
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• 제29권1호
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• pp.40-47
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• 2016

Background: Neuropathic pain, including paresthesia/dysesthesia in the lower extremities, always develops and remains for at least one month, to variable degrees, after percutaneous endoscopic lumbar discectomy (PELD). The recently discovered dual analgesic mechanisms of action, similar to those of antidepressants and anticonvulsants, enable nefopam (NFP) to treat neuropathic pain. This study was performed to determine whether NFP might reduce the neuropathic pain component of postoperative pain. Methods: Eighty patients, who underwent PELD due to herniated nucleus pulposus (HNP) at L4-L5, were randomly divided into two equal groups, one receiving NFP (with a mixture of morphine and ketorolac) and the other normal saline (NS) with the same mixture. The number of bolus infusions and the infused volume for 3 days were compared in both groups. The adverse reactions (ADRs) in both groups were recorded and compared. The neuropathic pain symptom inventory (NPSI) score was compared in both groups on postoperative days 1, 3, 7, 30, 60, and 90. Results: The mean attempted number of bolus infusions, and effective infused bolus volume for 3 days was lower in the NFP group for 3 days. The most commonly reported ADRs were nausea, dizziness, and somnolence, in order of frequency in the NFP group. The median NPSI score, and all 5 median sub-scores in the NFP group, were significantly lower than that of the NS group until postoperative day 30. Conclusions: NFP significantly reduced the neuropathic pain component, including paresthesia/dysesthesia until 1 month after PELD. The common ADRs were nausea, dizziness, somnolence, and ataxia.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제24권3호
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• pp.273-278
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• 2021

Purpose: Percutaneous endoscopic gastrostomy (PEG) is a safe method to feed patients with feeding difficulty. This study aimed to compare the outcomes of conventional PEG and laparoscopic-assisted PEG (L-PEG) placement in high-risk pediatric patients. Methods: In our tertiary pediatric department, 90 PEG insertions were performed between 2014 and 2019. Children with severe thoracoabdominal deformity (TAD), previous abdominal surgery, ventriculoperitoneal (VP) shunt, and abdominal tumors were considered as high-risk patients. Age, sex, diagnosis, operative time, complications, and mortality were compared among patients who underwent conventional PEG placement (first group) and those who underwent L-PEG placement (second group). Results: We analyzed the outcomes of conventional PEG placement (first group, n=15; patients with severe TAD [n=7], abdominal tumor [n=6], and VP shunts [n=2]) and L-PEG placement (second group, n=10; patients with VP shunts [n=5], previous abdominal surgery [n=4], and severe TAD [n=1]). Regarding minor complications, 1 (6.6%) patient in the first group underwent unplanned PEG removal and 1 (10%) patient in the second group had peristomal granuloma. We observed three major complications: colon perforation (6.6%) in a patient with VP shunt, gastrocolic fistula (6.6%) in a patient with Fallot-tetralogy and severe TAD, and pneumoperitoneum (6.6%) caused by early tube dislodgement in an autistic patient with severe TAD. All the three complications occurred in the first group (20%). No major complications occurred in the second group. Conclusion: In high-risk patients, L-PEG may be safer than conventional PEG. Thus, L-PEG is recommended for high-risk patients.

• The Korean Journal of Pain
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• 제35권1호
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• pp.97-105
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• 2022

Background: Percutaneous transforaminal endoscopic discectomy (PTED) has been widely used in the treatment of lumbar degenerative diseases. Epidural injection of steroids can reduce the incidence and duration of postoperative pain in a short period of time. Although steroids are widely believed to reduce the effect of surgical trauma, the observation indicators are not uniform, especially the long-term effects, so the problem remains controversial. Therefore, the purpose of this paper was to evaluate the efficacy of epidural steroids following PTED. Methods: We searched PubMed, Embase, and the Cochrane Database from 1980 to June 2021 to identify randomized and non-randomized controlled trials comparing epidural steroids and saline alone following PTED. The primary outcomes included postoperative pain at least 6 months as assessed using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). The secondary outcomes included length of hospital stay and the time of return to work. Results: A total of 451 patients were included in three randomized and two non-randomized controlled trials. The primary outcomes, including VAS and ODI scores, did not differ significantly between epidural steroids following PTED and saline alone. There were no significant intergroup differences in length of hospital stay. Epidural steroids were shown to be superior in terms of the time to return to work (P < 0.001). Conclusions: Intraoperative epidural steroids did not provide significant benefits, leg pain control, improvement in ODI scores, and length of stay in the hospital, but it can enable the patient to return to work faster.

• Clinical Endoscopy
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• 제56권4호
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• pp.391-408
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• 2023

With an aging population, the number of patients with difficulty in swallowing due to medical conditions is gradually increasing. In such cases, enteral nutrition is administered through a temporary nasogastric tube. However, the long-term use of a nasogastric tube leads to various complications and a decreased quality of life. Percutaneous endoscopic gastrostomy (PEG) is the percutaneous placement of a tube into the stomach that is aided endoscopically and may be an alternative to a nasogastric tube when enteral nutritional is required for four weeks or more. This paper is the first Korean clinical guideline for PEG developed jointly by the Korean College of Helicobacter and Upper Gastrointestinal Research and led by the Korean Society of Gastrointestinal Endoscopy. These guidelines aimed to provide physicians, including endoscopists, with the indications, use of prophylactic antibiotics, timing of enteric nutrition, tube placement methods, complications, replacement, and tube removal for PEG based on the currently available clinical evidence.