Search

Purpose Recently, randomized controlled trials have reported that conservative therapy can be a treatment option in patients with noncomplicated appendicitis. However, preoperative diagnosis of noncomplicated appendicitis is difficult. In this study, we determined predictive factors to distinguish patients with noncomplicated appendicitis from those with complicated appendicitis. Methods A total of 351 patients who underwent surgical treatment for acute appendicitis from January 2011 to December 2012 were included in this study. We classified patients into noncomplicated or complicated appendicitis groups based on the findings of abdominal computed tomography and pathology. We performed a retrospective analysis to find factors that could be used to discriminate between noncomplicated and complicated appendicitis. Results The mean age of the patients in the complicated appendicitis group (54.5 years) was higher than that of the patients in the noncomplicated appendicitis group (40.2 years) (P < 0.001), but the male-to-female ratios were similar. In the univariate analysis, the appendicocecal junction's diameter, appendiceal maximal diameter, appendiceal wall enhancement, periappendiceal fat infiltration, ascites, abscesses, neutrophil proportion, C-reactive protein (CRP), aspartate aminotransferase, and total bilirubin were statistically significant factors. However, in the multivariate analysis, the appendiceal maximal diameter (P = 0.018; odds ratio [OR], 1.129), periappendiceal fat infiltration (P = 0.025; OR, 5.778), ascites (P = 0.038; OR, 2.902), and CRP (P < 0.001; OR, 1.368) were statistically significant. Conclusion Several factors can be used to distinguish between noncomplicated and complicated appendicitis. Using these factors, we could more accurately distinguish patients with noncomplicated appendicitis from those with complicated appendicitis.

Purpose The purpose of this study is to evaluate the perioperative and long-term oncologic outcomes of hand-assisted laparoscopic surgery (HALS) and standard laparoscopic surgery (SLS) and assess the role of HALS in the management of right-sided colon cancer. Methods The study group included 53 patients who underwent HALS and 45 patients who underwent SLS for right-sided colon cancer between April 2002 and December 2008. Results The patients in each group were similar in age, American Society of Anesthesiologist (ASA) score, body mass index, and history of previous abdominal surgeries. Eight patients in the HALS group and no patient in the SLS group exhibited signs of tumor invasion into adjacent structures. No differences were noted in the time to return of normal bowel function, time to toleration of diet, lengths of hospital stay and narcotic usage, and rate of postoperative complications. The median incision length was longer in the HALS group (HALS: 7.0 cm vs. SLS: 4.8 cm, P < 0.001). The HALS group had a significantly higher pathologic TNM stage and significantly larger tumor size (HALS: 6.0 cm vs. SLS: 3.3 cm, P < 0.001). The 5-year overall, disease-free, and cancer-specific survival rates of the HALS and the SLS groups were 87.3%, 75.2%, and 93.9% and 86.4%, 78.0%, and 90.7%, respectively (P = 0.826, P = 0.574, and P = 0.826). Conclusion Although patients in the HALS group had more advanced disease and underwent more complex procedures than those in the SLS group, the short-term benefits and the oncologic outcomes between the two groups were comparable. HALS can, therefore, be considered an alternative to SLS for bulky and fixed right-sided colon cancer.

Purpose: The aim of our study was to identify risk factors associated with anastomotic leakage (AL) after an anterior resection (high anterior resection+low anterior resection) for rectal cancer. Methods: Between January 1998 and December 2007, 356 patients underwent an anterior resection for rectal cancer. Early anastomotic leakage (EAL) was defined as leakage identified during hospitalization. Late anastomotic leakage (LAL) was defined as leakage identified in outpatients. Results: AL (EAL+LAL) occurred in 30 patients (8.4%, mean time: 15.4 days). Among of them, EAL occurred in 20 patients (5.6%, mean time: 5.1 days), and LAL occurred in 10 patients (2.8%, mean time: 36.0 days). In the univariate analysis, the size of the tumor, the tumor level from the anal verge, and the level of anastomosis were significantly associated with AL. In EAL, the size of the tumor, the tumor level from the anal verge, the level of anastomosis, the operation type, and the value of serum albumin on day 3 after the operation were risk factors. In LAL, the tumor level from the anal verge and the level of anastomosis were risk factors. In the multivariate analysis, tumor size >7 cm (AL: P8 cm (AL: P=0.014, EAL: P=0.001) were independent risk factors. Conclusion: AL and EAL after an anterior resection for rectal cancer were related to the size of the tumor and the level of the tumor from the anal verge.

Purpose: In complicated diverticular disease, hand-assisted laparoscopic surgery (HALS) has been considered as a useful alternative treatment to standard laparoscopic surgery (SLS) and open surgery. As compared with standard laparoscopic surgery, HALS offers advantages such as tactile sense, better exposure, and shorter learning curve. Minimally invasive surgery is another advantage of HALS. The aim of this study was to compare SLS to HALS in patients with diverticular diseases of the small bowel and the colon. Methods: We retrospectively reviewed the records of 32 patients who had undergone SLS and HALS for diverticular disease between February 2002 and March 2009. Results: Of the 32 patients, 20 patients (62.5%) were in the SLS group, and 12 patients (37.5%) were in the HALS group. The mean maximal incision length was longer in the HALS group (SLS group vs. HALS group, 4.5 vs. 7.4 cm, P