• Journal of Gastric Cancer
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• v.11 no.4
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• pp.212-218
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• 2011

Purpose: Intracorporeal anastomosis during laparoscopic gastrectomy is becoming increasingly prevalent. However, selection of the anastomosis method after laparoscopic distal gastrectomy is equivocal because of a lack of technical feasibility and safety. We compared intracorporeal gastroduodenostomy with gastrojejunostomy using linear staplers to evaluate the technical feasibility and safety of intracorporeal anastomoses as well as its' minimally invasiveness. Materials and Methods: Retrospective analyses of a prospectively collected database for gastric cancer revealed 47 gastric cancer patients who underwent laparoscopic distal gastrectomy with either intracorporeal gastroduodenostomy or gastrojejunostomy from March 2011 to June 2011. Perioperative outcomes such as operation time, postoperative complication, and hospital stay were compared according to the type of anastomosis. Postoperative inflammatory response was also compared between the two groups using white blood cell count and high sensitivity C-reactive protein. Results: Among the 47 patients, 26 patients received gastroduodenostomy, whereas 21 patients received gastrojejunostomy without open conversion or additional mini-laparotomy incision. There was no difference in mean operation time, blood loss, and length of postoperative hospital stays. There was no statistically significant difference in postoperative complication or mortality between two groups. However, significantly more staplers were used for gastroduodenostomy than for gastrojejunostomy (n=6) than for gastroduodenostomy and (n=5). Conclusions: Intracorporeal anastomosis during laparoscopic gastrectomy using linear stapler, either gastroduodenostomy or gastrojejunostomy, shows comparable and acceptable early postoperative outcomes and are safe and feasible. Therefore, surgeons may choose either anastomosis method as long as oncological safety is guaranteed.

• Journal of Minimally Invasive Surgery
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• v.21 no.4
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• pp.148-153
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• 2018

Purpose: Single incision laparoscopic appendectomy (SILA) is a widely used surgical procedure for treatment of appendicitis with better cosmesis. However, many surgeons generally tend to choose conventional multiport laparoscopic appendectomy regarding with complicated appendicitis. The aim of this study is to demonstrate the safety and feasibility of SILA for treatment of complicated appendicitis by comparison with 3-ports conventional laparoscopic appendectomy (CLA). Methods: Retrospective chart review of patients diagnosed appendicitis at single hospital during January 2015 to May 2017 collected 500 patients. Among 134 patients with complicated appendicitis, we compared outcomes for 29 patients who got SILA and 105 patients who got CLA. Results: 179 and 321 patients were treated by SILA and CLA, respectively. 134 (26.8%) patients were treated for complicated appendicitis, 29 patients by SILA and 105 patients by CLA, respectively. There was no case converted to open or added additional trocar in both groups. There were no differences in demographics with regard to age, sex, body mass index (BMI), and American society of anesthesiologists (ASA) scores. There was no difference in mean operating time ($58.97{\pm}18.53$ (SILA) vs. $57.57{\pm}21.48$ (CLA), p=0.751). The drain insertion rate (6.9% vs 37.1%, p=0.001) and the length of hospital stay ($2.76{\pm}1.41$ vs. $3.97{\pm}2.97$, p=0.035) were lower in SILA group with significance. There was no significant difference in the rate of surgical site infection (6.9% vs. 6.7%, p=1.000). Conclusion: This study demonstrates that SILA is a feasible and safe procedure for treatment of complicated appendicitis.

• Hip & pelvis
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• v.34 no.3
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• pp.161-171
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• 2022

Purpose: The number of obese patients seeking total hip arthroplasty (THA) continues to expand despite body mass index (BMI) cutoffs. We sought to determine the outcomes of THA in the morbidly obese patient, and hypothesized they would have comparable outcomes to two cohorts of obese, and normal weight patients. Materials and Methods: THA performed on morbidly obese patients (BMI >40 kg/m²) at a single academic center from 2010 until 2020 were retrospectively reviewed. Eighty morbidly obese patients were identified, and matched in a 1:3:3 ratio to control cohorts with BMI 30-40 kg/m² and BMI <30 kg/m². Acute postoperative outcomes and BMI change after surgery were evaluated for clinical significance with univariate and regression analyses. Cox proportional hazard ratio was calculated to evaluate prosthetic joint infection (PJI) and revision surgery through follow-up. Mean follow-up was 3.9 years. Results: In the acute postoperative period, morbidly obese patients trended towards increased hospital length of stay, facility discharge and 90-day hospital returns. At final follow-up, a higher percentage of morbidly obese patients had clinically significant (>5%) BMI loss; however, this was not significant. Cox hazard ratio with BMI <30 kg/m² as a reference demonstrated no significant difference in survival to PJI and all-cause revision in the morbidly obese cohort. Conclusion: Morbidly obese patients (BMI >40 kg/m²) require increased resource expenditure in the acute postoperative period. However, they are not inferior to the control cohorts (BMI <30 kg/m², BMI 30-40 kg/m²) in terms of PJI or all-cause revisions at mid-term follow-up.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.1
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• pp.56-62
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• 2023

Backgrounds/Aims: Endoscopic retrograde cholangiopancreatography-guided gallbladder drainage (ERGD) is an alternative to percutaneous cholecystostomy (PTC) for hospitalized acute cholecystitis (AC) patients. Methods: We retrospectively analyzed propensity score matched (PSM) AC hospitalizations using the National Inpatient Sample database between 2016 and 2019 to compare the outcomes of ERGD and PTC. Results: After PSM, there were 3,360 AC hospitalizations, with 48.8% undergoing PTC and 51.2% undergoing ERGD. There was no difference in median length of stay between the PTC and ERGD cohorts (p = 0.110). There was a higher median hospitalization cost in the ERGD cohort, $62,562 (interquartile range [IQR] $40,707-97,978) compared to PTC, $40,413 (IQR $25,244-65,608; p < 0.001). The 30-day inpatient mortality was significantly lower in hospitalizations with ERGD compared to PTC (adjusted hazard ratio 0.16, 95% confidence interval [CI]: 0.1-0.41; p < 0.001). There was no difference in association with blood transfusions, acute renal failure, ileus, small bowel obstruction, and open cholecystectomy conversion (p > 0.05) between hospitalizations with ERGD and PTC. There was lower association of acute hypoxic respiratory failure (adjusted ratio [AOR] 0.46, 95% CI: 0.29-0.72; p = 0.001), hypovolemia (AOR 0.66, 95% CI: 0.49-0.82; p = 0.009) and higher association of lower gastrointestinal bleed (AOR 1.94, 95% CI: 1.48-2.54; p < 0.001) with ERGD compared to PTC. Conclusions: ERGD is a safer alternative to PTC in patients with AC. The risk complications are lower in ERGD compared to PTC but no difference exists based on mortality or conversion to open cholecystectomy.

• Survey Research
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• v.12 no.1
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• pp.65-88
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• 2011

This study analyzed the work and retirement behavior of middle- and old-aged Koreans using panel-data based multi-state life table models. Compared to previous studies that have mainly focused on gender differences in the work and retirement behavior, this study also analyzed educational differences in the retirement life course. With respect to the heterogeneity of work and retirement experiences, this study finds that the retirement life course of men and women differs substantially. Despite their longer life spans, women are expected to have shorter working life expectancies but live in a non-working state longer, resulting in a substantially higher proportion of non-working state in their lives. In terms of educational differences, this study finds that there is little difference in the expected length of stay in the labor force across educational levels but that poorly educated persons are more likely to spend a greater proportion of their lives in the labor force due to their shorter non-working life expectancies.

• Journal of Digital Convergence
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• v.11 no.10
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• pp.459-467
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• 2013

The purpose of this study was to identify the differences in medical care utilization by regional economic status using the National Hospital Discharge Patients Injury Survey. In order to determine economic status of each region, 234 cities and counties were categorized 5 quintiles according to their financial self-reliance ratio. The main results are as follows. First, low economic region has high age-standardized admission rate and standardized mortality rate. Second, of 16 major diseases, cerebrovascular and heart diseases, lung cancer, and stomach cancer reported greater changes in standardized mortality rate by regional economic status. Third, the rate of admission via emergency room in low economic region is higher than that of high economic region. Lastly, in the major illnesses, lower economic status led to an increase in average length of stay. Therefore, In order to bridge the gap in health inequality across regions, a regional medical policy tailored for each region and characteristics of the economic status should be established.

• Korean Journal of Community Nutrition
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• v.17 no.4
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• pp.407-418
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• 2012

Many displaced North Koreans (NK) are living in South Korea (SK); however nutrition research with the displaced NK is limited. This study examined food and nutrient consumption status of displaced NK children (6-18 year-old) currently living in SK. A total of 154 children were recruited, and a pre-tested dietary behavior questionnaire, food frequency questionnaire, 24-hr recall method were used. Sex- and age-matched SK children (n = 462) randomly selected from 2009-2010 Korea National Health and Nutrition Examination Survey were used as the comparison group. This study found that more NK children skipped breakfast (37%) and dinner (11%), and ate breakfast (38.8%) and dinner (18.2%) without family members than SK children. Many NK children reported that they rarely ate bread, rice cake, hamburger, pizza, fried food, candy. NK children consumed significantly less energy and nutrients (except calcium) and obtained more energy from fat and protein than SK children. Overall index of nutrient quality in NK children, however, was generally good. Length of stay in SK and breakfast skipping rates were significantly associated with lower diet quality. Therefore, nutrition education with displaced NK children should target those who recently came to SK. How to incorporate "new" foods, generally high in energy, sugar, or fat, in healthy ways and importance of breakfast should be emphasized. The growth patterns of the displaced NK children who were born and raised in food-deprived environments and will grow in food-affluent environments of SK should be monitored for health promotion of the NK children and for nutrition policy of the future united Korea.

• Journal of Korean Biological Nursing Science
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• v.23 no.4
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• pp.257-266
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• 2021

Purpose: The purpose of this study was to analyze the content of nursing interventions applied to patients with thoracic injury who visited a trauma emergency room (TER) or an emergency room (ER). Methods: Of 3,938 trauma patients admitted to this hospital between January 1, 2019 and December 31, 2020, 320 adult patients with thoracic injury (94 to TER, 226 to ER) who met the inclusion criteria were enrolled. Patients' data were acquired from their electronic medical records. General and clinical characteristics of these subjects along with nursing interventions were analyzed. Results: There were statistically significant differences in the length of stay, treatment outcome, and level of consciousness between thoracic injury patients who visited TER and ER. Average thoracic Abbreviated Injury Scale score and average Injury Severity Score of thoracic injury patients who visited TER were 3.13 and 13.54, respectively, which were significantly higher than those of patients who visited ER. The numbers of nursing actions applied was 4,819 for TER and 3,944 for ER, which were classified into five domains, 18 classes, and 56 interventions. The most domain of interventions carried out in both TER and ER was physiological: complex. Classes including Crisis management and Thermoregulation were not carried out in ER. On average, 16 more types of interventions were carried out in TER than in ER. Conclusion: This study demonstrated characteristics of thoracic injury patients and nursing interventions by emergency room type. Based on results of this study, standardized nursing interventions need be applied to thoracic injury patients visiting TER and ER.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.28 no.2
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• pp.155-160
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• 2024

Backgrounds/Aims: No reports to compare incisional hernia (IH) incidence between laparoscopic and open colorectal liver metastases (CRLM) resections have previously been made. This is the first comparative study. Methods: Single-center retrospective review of patients who underwent CRLM surgery between January 2011 and December 2018. IH relating to liver surgery was confirmed by computed tomography. Patients were divided into laparoscopic liver resection (LLR) and open liver resection (OLR) groups. Data collection included age, sex, presence of diabetes mellitus, steroid intake, history of previous hernia or liver resection, subcutaneous and peri-renal fat thickness, preoperative creatinine and albumin, American Society of Anesthesiologists (ASA) score, major liver resection, surgical site infection, synchronous presentation, and preoperative chemotherapy. Results: Two hundred and forty-seven patients were included with a mean follow-up period of 41 ± 29 months (mean ± standard deviation). Eighty seven (35%) patients had LLR and 160 patients had OLR. No significant difference in the incidence of IH between LLR and OLR was found at 1 and 3 years, respectively ([10%, 19%] vs. [10%, 19%], p = 0.95). On multivariate analysis, previous hernia history (hazard ratio [HR], 2.22; 95% confidence interval [CI], 1.56-4.86) and subcutaneous fat thickness (HR, 2.22; 95% CI, 1.19-4.13) were independent risk factors. Length of hospital stay was shorter in LLR (6 ± 4 days vs. 10 ± 8 days, p < 0.001), in comparison to OLR. Conclusions: In CRLM, no difference in the incidence of IH between LLR and OLR was found. Previous hernia and subcutaneous fat thickness were risk factors. Further studies are needed to assess modifiable risk factors to develop IH in LLR.

• Journal of Chest Surgery
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• v.32 no.8
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• pp.722-725
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• 1999

Background: To secure a rapid and safe approach which is at the same time cosmetically appealing, we employed the right anterolateral thoracotomy incision for repair of atrial septal defects and valvular heart diseases in the adult. Material and method: Between October 1989 and June 1998, 44 adult patients underwent open heart surgery through right anterolateral thoracotomy at our institution. Operative time, cardiopulmonary bypass time, aortic cross clamp time, blood loss until chest tube removal, length of ICU stay, days to discharge, and survival were compared with those that received cardiac surgery via conventional sternotomy. Result: No significant differences were observed between the two groups. There was no death and no additional morbidity directly related to this approach. Cosmetically satisfying results were obtained with safety using the right anterolateral thoracotomy approach. Conclusion: Our data show that the right anterolateral thoracotomy approach is a safe alternative to conventional median sternotomy as it offers excellent exposure and aesthetically more acceptable wounds while not adding on to the operative risks.