• 한국간담췌외과학회지
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• 제27권3호
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• pp.301-306
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• 2023

Backgrounds/Aims: Postoperative delirium (POD) is a common complication that increases mortality and morbidity in older patients. This study aimed to evaluate the clinical significance of post-cholecystectomy delirium in older patients. Methods: This retrospective study included 201 patients aged > 75 years who underwent cholecystectomy for acute or chronic cholecystitis between January 2016 and December 2019. Patients were divided into the POD (n = 21) and non-POD (n = 180) groups, and their demographic features and clinical results were compared. Results: The mean patient age was 78.88 years; the female/male ratio was 44.8%/55.2%. Laparoscopic surgery was performed in 93.5% of patients. The univariate analysis showed that lower body mass index (BMI), immobilized admission status, neuropsychiatric disease history, preoperative intervention (percutaneous drainage), high C-reactive protein, hypoalbuminemia, neutrophilia, hypo-/hyperkalemia, and longer operative time were more frequently observed in the POD group. The multivariate analysis showed that lower BMI (odds ratio [OR], 2.796; p = 0.024), neuropsychiatric disease history (OR, 3.019; p = 0.049), hyperkalemia (OR, 5.972; p = 0.007), and longer operative time (OR, 1.011; p = 0.013) were significant risk factors for POD. Conclusions: POD was associated with inflammation degree, general condition, poor nutritional status, electrolyte imbalance, and stressful conditions. Recognizing risk factors requiring multidisciplinary team approaches is important to prevent and treat POD.

• 융합정보논문지
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• 제10권10호
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• pp.80-87
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• 2020

본 연구의 목적은 투관침 부위를 중심으로 복강경하 담낭절제술에 적용하는 소독제인 포비돈 아이오딘과 클로르헥시딘-에탄올에 따른 소독효과의 차이를 비교하기 위한 비동등성 대조군 사전사후설계 실험연구이다. 연구대상자는 서울 소재 1개의 대학병원 외과에 입원한 46명의 환자를 대상으로 난수표를 이용하여 무작위 할당하였으며, 균의 배양과 동정, 균 수(CFU/ml) 측정, 수술부위감염 발생 유무를 통해 소독제 효과의 차이를 비교하였다. 연구결과, 포비돈 아이오딘과 클로르헥시딘-에탄올은 소독 3분 후와 투관침 제거 전의 균 발생률, 균수 변화의 차이와 수술부위감염발생률은 통계적으로 유의한 차이가 없어 소독효과에 대한 차이는 없는 것으로 나타났다. 따라서, 적절한 소독제 선택시 소독효과 뿐만 아니라 비용적 측면과 사용의 편의성 등을 고려하는 것이 필요하다. 본 연구는 소독제의 효능과 사용방법에 대한 기초자료 및 교육 자료로 활용될 수 있으며, 소독제에 대한 이해를 높이는데 의의가 있다.

• 한국간담췌외과학회지
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• 제28권2호
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• pp.203-213
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• 2024

Backgrounds/Aims: The standard treatment for acute cholecystitis, biliary pancreatitis and intractable biliary colics ("hot gallbladder") is emergency laparoscopic cholecystectomy (LC). This paper aims to identify the prognostic factors and create statistical models to predict the outcomes of emergency LC for "hot gallbladder." Methods: A prospective observational cohort study was conducted on 466 patients having an emergency LC in 17 months. Primary endpoint was "suboptimal treatment," defined as the use of escape strategies due to the impossibility to complete the LC. Secondary endpoints were postoperative morbidity and length of postoperative stay. Results: About 10% of patients had a "suboptimal treatment" predicted by age and low albumin. Postop morbidity was 17.2%, predicted by age, admission day, and male sex. Postoperative length of stay was correlated to age, low albumin, and delayed surgery. Conclusions: Several predictive prognostic factors were found to be related to poor emergency LC outcomes. These can be useful in the decision-making process and to inform patients of risks and benefits of an emergency vs. delayed LC for hot gallbladder.

• 한국임상수의학회지
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• 제28권5호
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• pp.497-505
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• 2011

자연개구부를 통한 내시경적 수술 (NOTES)은 최근 많은 잠재적인 장점들로 인해 새롭게 주목받고 있는 수술방법이다. 하지만 국내에서 대부분 사용되어지고 있는 내시경은 기구가 삽입되는 포트가 한 개인 것이 대부분으로 순수 NOTES를 시행하기에는 다소 어려움이 있을 수 있다. 이에 본 실험에서는 복강경과 순수 NOTES의 중간 단계 인 하이브리드 NOTES를 통해 담낭절제술을 실시하였다. 이 방법은 한 개의 복강경 포트를 삽입함으로써 이를 통해 복강경용 겸자를 사용하여 담낭의 견인 역할을 할 수 있다는 장점을 지닌다. 내시경은 경위장관, 경결장 및 경질을 통 해 외부 피부 절개 없이 복강 내로 삽입되어 수술이 진행되었으며 복강 내압은 $CO_2$를 이용하여 4 mmHg로 유지하였다. 위 세 경로를 통한 접근으로 담낭절제술은 모두 성공적으로 이루어졌으며 모든 실험견들은 실험기간동안 임상적인 유의성 없이 좋은 회복을 나타내었다. 본 연구를 통해 개에서 최소 침습적 수술로 담낭절제술을 실시할 수 있는 방법을 확립하고 시술 시에 발생할 수 있는 부작용 등을 확인함으로써 소동물 수의 임상영역에서 최소 침습적 수술이 보급될 수 있는 기초가 되며, 복강경과 내시경의 임상 활용도를 높일 수 있을 것으로 생각된다. 하지만 경결장의 경우 내시경 접근 시 복강 내에서 소수의 세균 감염이 확인되었으며 경결장 접근의 경우 접근 방법에 대한 다른 연구가 필요할 것으로 생각된다.

• 한국간담췌외과학회지
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• 제27권3호
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• pp.322-327
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• 2023

Situs inversus totalis (SIT) is a rare condition in which cardiac and abdominal organs are inverted from their normal left-sided orientation. Mirizzi syndrome, characterized by the obstruction of the common hepatic duct or the common bile duct by gallstone, is a rare condition. Mirizzi syndrome co-occurrence in SIT patients is rare. Gallbladder in sinistroposition is extremely uncommon in SIT patients. We report a known case of diabetes, ventricular septal defect with transposition of the great arteries in a 32-year-old female who presented with jaundice, cholangitis, chills, and fever that had lasted for 10 days. She was confirmed to have SIT with type III Mirizzi syndrome following a series of diagnostic procedures. Primarily, endoscopic retrograde cholangiopancreatography along with common bile duct stenting was performed to initially reduce cholangitis. After an eight-week follow-up after the reduction of cholangitis, surgery was conducted. Mirror-imaged ports were used for the laparoscopic procedure, and the surgeon was on the patient's right side rather than the usual left side. The patient was discharged from the hospital following two days of uneventful healing.

• 한국간담췌외과학회지
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• 제26권4호
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• pp.339-346
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• 2022

Backgrounds/Aims: To investigate if the increase in the number of cholecystectomies is proportional to symptomatic gallbladder-associated hospital admissions in Australia and Aotearoa New Zealand (NZ). Methods: National healthcare registries were used to obtain data on all episodes of cholecystectomies and hospital admissions for patients ≥ 15 years from public and private hospitals. Results: Between 2004 and 2019, in Australia, there have been 1,074,747 hospital admissions and 779,917 cholecystectomies, 715,462 (91.7%) of which were laparoscopic, and 163,084 admissions and 98,294 cholecystectomies in NZ. The 15-54 years age group saw an increase in operative rates, +4.0% in Australia and +6.6% in NZ, and admissions, +3.7% and +5.8%, respectively. Hospital admissions decreased by -9.8% in Australia but the proportion of patients undergoing intervention increased by 10.8% (from 67.1% to 75.0% of hospital admissions). Procedural rates increased by +7.3% in NZ with no change in the intervention rate. Conclusions: In Australia, there has been a decline in symptomatic gallbladder-associated hospital admissions and a rise in intervention rate. Admissions and interventions have increased proportionally in NZ. There are higher rates of cholecystectomy and admission amongst younger demographics, compared to historical cohorts. Future research should focus on identifying risk factors for increased disease and operative rates amongst younger populations.

• Journal of Trauma and Injury
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• 제34권4호
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• pp.294-298
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• 2021

Extrahepatic biliary tract and gallbladder injuries following blunt abdominal trauma are uncommon. Traumatic cystic duct transection is even rarer, which has frequently caused missed diagnosis and delayed treatment. An 18-year-old female patient with no past medical history was transferred to the Trauma Center of Kyungpook National University Hospital after falling from a height of approximately 20 meters. She became hemodynamically stable after initial resuscitation, and initial contrast-enhanced abdominal computed tomography (CT) showed right kidney traumatic infarction and multiple intrahepatic contusions with minimal fluid collection but no extravasation of the contrast. She was admitted to the intensive care unit. On the second day of hospitalization, her abdomen became distended, with follow-up CT showing a large collection of intra-abdominal fluid. Laparoscopic exploration was then performed, which revealed devascularization of the gallbladder with complete transection of the cystic duct and artery. Laparoscopic cholecystectomy was performed, as well as primary closure of the cystic duct orifice on the common bile duct using a 4-0 Prolene suture. After surgery, no clinical evidence of biliary leakage or common bile duct stricture was observed.

• Journal of Gastric Cancer
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• 제13권4호
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• pp.199-206
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• 2013

Since the first transgastric natural orifice transluminal endoscopic surgery was described, various applications and modified procedures have been investigated. Transgastric natural orifice transluminal endoscopic surgery for periotoneoscopy, cholecystectomy, and appendectomy all seem viable in humans, but additional studies are required to demonstrate their benefits and roles in clinical practice. The submucosal tunneling method enhances the safety of peritoneal access and gastric closure and minimizes the risk of intraperitoneal leakage of gastric air and juice. Submucosal tunneling involves submucosal tumor resection and peroral endoscopic myotomy. Peroral endoscopic myotomy is a safe and effective treatment option for achalasia, and the most promising natural orifice transluminal endoscopic surgery procedure. Endoscopic full-thickness resection is a rapidly developing natural orifice transluminal endoscopic surgery procedure for the upper gastrointestinal tract and can be performed with a hybrid natural orifice transluminal endoscopic surgery technique (combining a laparoscopic approach) to overcome some limitations of pure natural orifice transluminal endoscopic surgery. Studies to identify the most appropriate role of endoscopic full-thickness resection are anticipated. In this article, I review the procedures of natural orifice transluminal endoscopic surgery associated with the upper gastrointestinal tract.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제15권1호
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• pp.57-61
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• 2012

Cholelithiasis and choledocholithiasis are uncommon pediatric diseases, although clinicians have seen them with increasing frequency in children in recent years. Moreover, no case of Epstein-Barr virus (EBV) infection with cholelithiasis and choledocholithiasis has been previously reported in the English literature. We report a pediatric patient with EBV infection, a gall bladder stone, and a common bile duct stone, may have had GB and CBD stones prior to her EBV infection, whom we successfully treated with antibiotics and laparoscopic cholecystectomy for cholecystitis.

• Advances in pediatric surgery
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• 제2권1호
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• pp.53-58
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• 1996

Congenital duplication of the gallbladder, including true duplication and septated gallbladder, is an uncommon but potentially complicated malformation. It presents biliary colic associated with acute or chronic cholecystitis. It can be diagnosed preoperatively by various imaging tools such as real-time ultrasonography, biliary scintigraphy, oral cholecystography, or endoscopic retrograde cholangiography. It can be safely managed by either laparoscopic or open procedures. This report describes a 6-year-old girl with true duplication of gallbladder diagnosed preoperatively by real-time ultrasonography and treated by open cholecystectomy.