, Ki-Nam Shim, Won Young Cho, Chan Young Kim, Hyeon-Ju Kang, Mi Yeon Kim, So Young Ahn, Yoon Pyo Lee, Hyoung Won Cho, Sung Ae Jung, Joo-Ho Lee Laparoscopic sleeve gastrectomy can reduce morbidity and mortality in patients with morbid obesity, but it can cause complications such as a gastrointestinal leak. A 30-year-old morbidly obese female who had type 2 diabetes mellitus and hypertension with estimated body mass index of 40.2 kg/m2 was admitted. Laparoscopic sleeve gastrectomy was performed. On postoperative day 19, a leak was suspicious on physical examination and radiologic findings. Conservative management was performed, but the patient was hemodynamically unstable and imminently septic. After laparoscopic drainage procedure, esophagogastroduodenoscopy was performed and revealed the fistula opening at staple line just below gastroesophageal junction. Fibrin tissue adhesive was injected around the fistula and the esophageal covered stent was inserted to cover the leak. At 14th days after stent insertion, the barium study confirmed no more leak. In this case, we experienced that the esophageal stent insertion with fibrin tissue adhesive injection may reduce recovery time of the fistula developed after laparoscopic sleeve gastrectomy.
, Joo-Ho Lee, Ju Young Seoh Recently the advantages of a laparoscopy-assisted distal gastrectomy(LADG) including lymphadenectomy for early gastric cancer(EGC) have been reported. The purpose of this study was to perform a prospective randomized trial comparing the early results of LADO with open distal gastrectomy in EGC.
Forty-seven patients, endoscopically diagnosed as EGC on antrum and lower body, were included during the period from November 2001 to August 2003. Using a random number table, 23 patients were assigned to open group(group O) and 24 patients to LADG group(group L). Radical distal subtota 1gastrectomy with gastroduodenostomy was performed in all patients. The clinicopathologic findings, postoperative recovery, and morbidity were compared between two groups.
Age, sex, body weight, associated disease, history of previous abdominal surgery, location of lesion, size, gross type of EGC, and histologic differentiation were similar in both groups. On permanent pathologic examination, all cases of group O were diagnosed as EGC and in the group L, 21 cases were EGC, 3 cases were advanced cancer. The mean operation time was significantly shorter in the group L, but estimated blood loss and transfusion amount were similar in both groups. The mean postoperative days of first flatus, starting day of diet, postoperative hospital stay were shorter and deration of analgesic administered were lower in group O, but they did not reach statistical significance. The mean numbers of harvested lymph nodes were 38.1 in the group O and 31.8 in the group L, which was not statistically significant(p=0.098). Postoperative pulmonary complication based on chest X-ray occurred more frequently in the group O (p=0.043). There is no recurrence of disease in both groups in follow-ups.
LADG has advantage in terms of less phlmonary complications while main-taining the curatility. This is the preliminary result of prospective randomized study and the long-term results should be followed.
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