• Journal of Korean Neurosurgical Society
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• v.29 no.3
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• pp.330-335
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• 2000

Objective : The purpose of this report is to assess the morbidity and mortality associated with clipping of intracranial unruptured aneurysms. Methods : At the authors' institution between May 1989 and December 1998, a total of 128 unruptured aneurysms in 110 patients were treated with surgical clippings. The medical records and neuroimaging studies of the patients were reviewed retrospectively. Results : The main locations of the aneurysms were : middle cerebral artery 31%, internal carotid-posterior communicating artery 28%, anterior communicating artery 16%, paraclinoid 6.5%, internal carotid-anterior choroidal artery 7%, posterior circulation 7%. Forty three percent of the aneurysms were symptomatic and 57% asymptomatic. The overall outcome of the surgery was : Glasgow outcome scale(GOS) I 86%, GOS II 6%, GOS III 4.3%, GOS IV 0% and GOS V(death) 3.5%. The operative risk is higher for large to giant aneurysms, and for aneurysms in posterior circulations. Patients with non-giant aneurysm in anterior circulation showed no mortality, but morbidity of 8.2%, and in posterior circulation : 25% of mortality and 75% of morbidity. Patients with giant anterior circulation aneurysm have 22% of mortality and 22% of morbidity. For patients with giant posterior circulation aneurysm, mortality and morbidity were 25% and 25%, respectively. The postoperative deaths were related to occlusion of the major parent artery in 3 cases(75%). The postoperative morbidity was related to occlusion of artery(9/13), intraoperative rupture(3/13), and cranial nerve injury(1/13). Conclusion : This report documents 3.5% mortality and 13% of morbidity in the clipping surgery for unruptured intracranial aneurysms, and the relatively low risk of surgical clipping in non-giant and those located in anterior circulation. The natural history, especially risk of bleeding, of the unruptured intracranial aneurysms is still controversial. However, with respect to surgical results, unruptured non-giant aneurysm located in anterior circulation should be operated in patients with low risk.

• Journal of Korean Neurosurgical Society
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• v.40 no.2
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• pp.99-102
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• 2006

Objective : To document surgical mortality and morbidity for the treatment of unruptured intracranial aneurysms, and to identify optimal treatment modalities, the authors reviewed and analyzed the surgical results. Methods : The authors reviewed 49 cases of unruptured intracranial aneurysm without a previous history of subarachnoid hemorrhage from March 1984 through December 2003. Unruptured intracranial aneurysms were categorized as asymptomatic and symptomatic, and operative results were assessed using the Karnofsky scale at 3 months postoperatively. Outcomes were defined as 'excellent' for a Karnofsky scale score of 100, 'good' for a score of $80{\sim}90$, 'fair' for $50{\sim}70$, 'poor' for $10{\sim}40$, or as 'death'. Excellent and good results were defined as a 'favorable' outcome and others as 'unfavorable' outcome. Results : Of the 49 study subjects, 45 had a favorable outcome and 4 an unfavorable outcome. Surgical mortality was 6.1% and surgical morbidity was 2.0% for all subjects. And the symptomatic group had more complications. Conclusion : There were no significant relationships between aneurysmal size, location, and preoperative symptoms with surgical results. And we believe that the reasons for morbidity and mortality are attributable to strokes, thus more attention should be paid to peri- and post-operative patients care with a focus on strokes prevention in the symptomatic group.

• Journal of Chest Surgery
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• v.31 no.11
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• pp.1049-1055
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• 1998

Background: Coronary artery bypass surgery is an important treatment for ischemic heart disease. Recently operative mortality and morbidity has decreased, however further improvement is necessary. Materials and methods: This study was designed to evaluate the risk of operative mortality and morbidity by retrospective method. From 1992 to 1997, eighty six patients underwent coronary artery bypass surgery. There were 61 males and 25 females aged 36~74 years(mean, 58.6). Fourteen patients(16%) had previous PTCA or stent insertion, 41 patients(48%) had unstable angina, and 45 patients(52%) had three vessel disease. Patients with low LV ejection fraction(<35%) were 7 cases and urgent or emergent operation were 10 cases. There were 6 cases of combined surgery which were mitral valve replacement(2 cases), aortic valve replacement(2 cases), ASD repair(1 case), and VSD repair(1 case). Average number of distal anastomosis was 3.5 per patient and average aortic cross clamp time was 115±38.3min. Preoperative risk factors were defined as follows: female, old age(>70 years), low body surface area(<1.5M2), PTCA or stent insertion history, hypercholesterolemia, smoking, hypertension, DM, COPD, urgent or emergent operation, left main disease, low LV ejection fraction(<35%), and combined surgery. Results: Operative mortality was 7cases(8%). As a postoperative morbidity, perioperative myocardial infarction was 6 cases, cerebrovascular accident 6 cases, reoperation for bleeding 5 cases, acute renal failure 4 cases, gastrointestinal complication 3 cases, and mediastinitis 3 cases. In the evaluation of operative risk factors, low body surface area, DM and low LV ejection fraction were found to be predictive risk factors of postoperative morbidity(p<0.05), and low ejection fraction was especially a risk factor of hospital mortality(p<0.05). Conclusions: In this study, low body surface area, DM and low LV ejection fraction were risk factors of postoperative morbidity and low ejection fraction was a risk factor of hospital mortality.

• Journal of Gastric Cancer
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• v.15 no.3
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• pp.151-158
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• 2015

Purpose: Obesity is associated with morbidity following gastric cancer surgery, but whether obesity influences morbidity after laparoscopic gastrectomy (LG) remains controversial. The present study evaluated whether body mass index (BMI) and visceral fat area (VFA) predict postoperative complications. Materials and Methods: A total of 217 consecutive patients who had undergone LG for gastric cancer between May 2003 and December 2005 were included in the present study. We divided the patients into two groups ('before learning curve' and 'after learning curve') based on the learning curve effect of the surgeon. Each of these groups was sub-classified according to BMI (<$25kg/m^2$ and ${\geq}25kg/m^2$) and VFA (<$100cm^2$ and ${\geq}100cm^2$). Surgical outcomes, including operative time, quantity of blood loss, and postoperative complications, were compared between BMI and VFA subgroups. Results: The mean operative time, length of hospital stay, and complication rate were significantly higher in the before learning curve group than in the after learning curve group. In the subgroup analysis, complication rate and length of hospital stay did not differ according to BMI or VFA; however, for the before learning curve group, mean operative time and blood loss were significantly higher in the high VFA subgroup than in the low VFA subgroup (P=0.047 and P=0.028, respectively). Conclusions: VFA may be a better predictive marker than BMI for selecting candidates for LG, which may help to get a better surgical outcome for inexperienced surgeons.

• Journal of Korean Foot and Ankle Society
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• v.10 no.2
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• pp.150-155
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• 2006

Purpose: The purpose of this study is to assess the results of the autologous osteochondral grafting harvested from medial side of talus for relatively large osteochondral lesion of the medial talar dome. Materials and Methods: From October 2004 to September 2005, 12 patients with osteochondral lesion measured more than 10 mm in axial MRI who were followed up more than 1 year after operation were analyzed. We evaluated postoperative symptoms by Mann and Reynolds scale, morbidity of donor site, and compared the range of both ankle motion. We also evaluated the union at the medial malleolar osteotomy site, trabecular connection between the grafted osteochondral mass and talus, irregularity of the articular surface in lesion. Results: Clinical results were rated as excellent in 4, good in 7, fair in 1. The mean angle of the total range of motion in affected ankle was decreased by 3 degrees compared to that in unaffected ankle. We did not observe abnormal findings at donor site. The osteotomized bone was united at mean 9 weeks (range, 8-12 weeks). We observed trabecular connection between grafted osteochondral mass and talus at mean 14 weeks (range, 12-16 weeks). We also observed irregular articular surface in osteochondral lesions in 6, smooth articular surface in 6. Conclusion: The local autologous osteochondral graft for relatively large osteochondral lesion of the medial talar dome is useful operative method with advantages of wide operative field, low morbidity of donor site, and high satisfaction rate.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.1
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• pp.20-27
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• 2023

There are many variations and unclear definitions of the appropriate timing of laparoscopic cholecystectomy (LC) after endoscopic retrograde cholangiopancreatography (ERCP), and there is still a lack of consistency about the appropriate timing. Inappropriate timing can be associated with serious comorbidity and can affect the patients. This meta-analysis was conducted to assess the operative outcomes and morbidity to provide a benefit to the patients based on the best timing of LC after ERCP. Randomized controlled trials (RCTs) and retrospective studies were identified from the PubMed and Scopus databases from inception to July 2021. A meta-analysis was performed to estimate the treatment effects on operative outcomes and morbidity. Four RCTs and four retrospective studies met our inclusion criteria. A meta-analysis indicated that patients who received LC after ERCP on the same day or within 72 hours had about 0.354 days shorter length of hospital stay with a shorter operative time of about 0.111-1.835 minutes and a lower risk of complications around 37%-73%. Our evidence suggests that the appropriate timing of LC after ERCP is either the same day or within 72 hours for treating cholelithiasis patients based on the severity of disease.

• Archives of Reconstructive Microsurgery
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• v.6 no.1
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• pp.80-86
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• 1997

The lateral arm flap was reported first by Song et al. in 1982, and Katsaros and colleagues described an anatomic study and clinical cases in 1984. This flap is thin, has relatively constant vascular anatomy, and provides relatively acceptable scar at the donor site. Despite its many advantages its wide application has been limited by its short vascular pedicle with small diameter of lumen, and its small skin paddle. We studied its anatomical structure to get longer length of vascular pedicle, wide diameter and thinner part of flap beyond the lateral condyle through 6 fresh cadaver dissection and dye injection study. We experienced 21 cases of lateral arm free flaps and 26 cases of forearm free flaps from May, 1992 to January, 1996. We compared its usefulness with forearm free flaps in the aspects of donor morbidity, operative factors, quality of flap, and versatility. In conclusion, lateral arm flap can replace the role of forearm flap in most cases so that patient's donor morbidity can be reduced especially in the women.

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1337-1345
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• 1992

One hundred and fourty-one Bjork-Shiley Monostrut valves were implanted in 105 consecutive patients from November 1983 to February 1990. There were 61 male and 44 female patients with a mean age of 33.6 years at the surgery. The cummurative follow-up was 370.3 patient-years with a mean of 44.0 months per patient. The operative mortality rate was 3.8%, and the linealized late mortality was 1.18%/patient-year. The incidence of major complications were 4.59%/patient-year, and the actuarial rate of freedom from valve-related morbidity was 80.2$\pm$4.4% at 7 years. The 7-year survival rate was 90.5$\pm$4.1%, and the actuarial rate of freedom from thromboembolism at 7 years was 93.3$\pm$2.3%. The linealized annual rates of complication were ; structural valve failure 0.27% /patient-year, non-structural valve failure 0.54% /patient-year, thromboembolism 1.62% /patient-year; bleeding 1.62% /patient-year; endocarditis 0.54% /patient-year. On the basis of our experience, we judged the Bjork-Shiley Monostrut valve reliable, with similar incidence of valve-related morbidity of other mechanical prosthetic valves.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.20 no.4
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• pp.252-258
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• 2017

Purpose: Blunt trauma of pancreas in children is uncommon and its management varies from observational to early operative intervention. We analysed the feasibility and outcome of non-operative management in all grades of paediatric pancreatic injuries. Methods: A total of 15 patients of pancreatic trauma seen in a Paediatric Surgery Unit were retrospectively analyzed. Results: Age of the patients ranged from 3-11 years (mean, 7.7 years). The mode of injury was local trauma in 9 children. Only 3 patients had associated injuries and all were haemodynamically stable. Serum amylase levels were raised in 12 patients at admission which ranged from 400-1,000 IU. Computed tomography scan made a correct diagnosis in 14 patients. Grades of the injury varied from grade I-V (1, 3, 6, 4, 1 patients respectively). Fourteen patients were managed conservatively. One patient underwent laparotomy for suspected superior mesenteric hematoma. The average duration of enteral feeds was 3.7 days and of hospital stay was 9.4 days. Six patients formed pancreatic pseudocysts; two were managed conservatively while the other four underwent cystogastrostomy. The patients were followed up for a period of 1-12 years. All remained asymptomatic and none had exocrine or endocrine deficiencies. Conclusion: Non-operative treatment for isolated blunt trauma of pancreas in children may be safely followed for all the grades of injury; if associated injuries requiring surgical intervention are ruled out with a good quality imaging and the patients are hemodynamically stable. It did not increase the hospital stay and morbidity and avoided operative intervention on acutely injured pancreas.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.1
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• pp.76-86
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• 2023

Backgrounds/Aims: The aim of this study was to describe short- and long-term outcomes of patients who underwent pancreatoduodenectomy (PD) at a typical United Kingdom hepatopancreatobiliary unit. Methods: A retrospective analysis of all PD patients with histologically-confirmed pancreatic ductal adenocarcinoma (PDAC), ampullary adenocarcinoma (AA), or distal cholangiocarcinoma (CC) from September 1st, 2006 to May 31st, 2015 was carried out. The following information was obtained: demographics, comorbidities, preoperative investigations, neoadjuvant treatment, operative details, postoperative management, complications, adjuvant treatment, five-year recurrence, and five-year survival. Effects of selected preoperative variables on short- and long-term outcomes were investigated. Results: Of 271 included patients, 57.9% had PDAC, 25.8% had AA, and 16.2% had CC. In total, 67.9% experienced morbidity and 17.3% developed a Clavien-Dindo grade ≥ III complication. The 90-day mortality was 3.3%. Clinically-relevant postoperative pancreatic fistula, bile leak, gastrojejunal leak, postpancreatectomy haemorrhage and delayed gastric emptying affected 8.1%, 4.1%, 0.0%, 9.2%, and 19.9% of patients, respectively. American Society of Anesthesiologists grade III-VI correlated with overall morbidity (p = 0.002) and major morbidity (p = 0.009), but not 90-day mortality or five-year survival. The same pattern was observed in patients with a preoperative serum bilirubin > 29 µmol/L and/or a neutrophil/lymphocyte ratio > 3.1. Five-year cancer recurrence and five-year survival were 68.3% and 22.5%, respectively. PDAC patients had higher five-year recurrence but lower five-year survival rates (both p = 0.001). Conclusions: In our series, the majority of patients experienced a complication. However, few patients experienced major morbidity. Surgical risk factors did not affect five-year survival.