PurposeThe purpose of this study was to investigate the safety and usefulness of the Hem-o-lok clip for the closure of appendicular stumps and limitations of the Hem-o-lok clip.MethodsFrom May 2010 to August 2011, 105 consecutive patients underwent laparoscopic appendectomies by three surgeons. XL size Hem-o-lok clips were used for the closure of appendicular stumps by one surgeon. The remaining surgeons used double endoloop ligatures. Prospectively collected data from patients who underwent laparoscopic appendectomy due to acute appendicitis were retrospectively reviewed.ResultsA total of 105 laparoscopic appendectomies were performed. The endoloop group consisted of 66 patients (mean age, 34.6 years; range, 16 to 82 years), while the Hem-o-lok group consisted of 39 patients (mean age, 43.5 years; range, 11 to 88 years). In three cases, the Hem-o-lok clip was not used due to enlargement and severe inflammation of the appendix base. No specific intraoperative or postoperative complications were observed in either group.ConclusionThe use of Hem-o-lok clips for the closure of appendicular stumps in laparoscopic appendectomy is a feasible, safe, fast and cost-effective procedure in patients with a mildly to moderately inflamed appendix base of less than 10 mm in diameter.

Laparoscopic repair of paraduodenal hernia in children and infants is safe and feasible. We recommend the laparoscopic repair as the first surgical option for paraduodenal hernia.

Purpose: Muscular artery differs from elastic artery in physical properties and constituents of the arterial wall.To investigate the difference between muscular and elastic arteries, we measured the pulse wave velocities (PWVs) in lower extremity muscular arteries (femoral ankle PWV, faPWV) and abdominal elastic arteries (brachial femoral PWV, bfPWV), and searched for the relationships between the PWVs of muscular, elastic arteries and the risk factors of arteriosclerosis. Methods: 184 normal volunteers were enrolled in the study. Among them, the ratios of male/female, smoker/ non-smoker, and hypertension/normal were 81/103, 66/118, and 63/121, respectively. Using volume plethysmography, faPWV and bfPWV were measured. The risk factors of arteriosclerosis in this study were age, gender, smoking, hypertension, body mass index, low density lipoprotein, high density lipoprotein, triglyceride, hemoglobin A1C, and white blood cell. Results: The PWVs of lower extremity muscular arteries (faPWVs) were significantly faster than those of abdominal elastic arteries (bfPWVs) (right, P＜0.001; left, P＜0.001) Multiple regression analysis revealed that the independent risk factors of the PWV were age (right, P＜0.001; left, P＜0.001) and gender (right, P=0.008; left, p=0.014) in abdominal elastic arteries. However, in lower extremity muscular arteries, hypertension (right, P＜0.001; left, P ＜0.001) as well as age (right, P＜0.001; left, P＜0.001) and gender (right, P=0.009; left, P=0.001) were other significant independent risk factors. Conclusion: The PWVs of lower extremity muscular arteries were significantly faster than those of abdominal elastic arteries. The significance of hypertension in faPWV suggests that hypertension is an important risk factor in inducing arterial stiffness, especially in lower extremity muscular arteries. (J Korean Surg Soc 2010;79:481-485)

Purpose:The liver hanging maneuver (LHM) is a useful technique enabling a safe anterior approach, which is one of the most important innovations in the field of major hepatic resections. This study was conducted to review tumors' profiles after applying this procedure and to evaluate the usefulness of LHM and Glissonean pedicle transaction method (GPTM). Methods: Medical records of 64 patients who underwent hepatic resection using LHM and GPTM at the Asan Medical Center were reviewed. The classic LHM was conducted according to the Belghiti method. Results: Among 64 patients, 46 patients had hepatocellular carcinoma; 7, intrahpatic cholangiocarcinoma; 4, hilar cholangiocarcinoma; 4, metastatic liver cancer; 3, benign liver tumor. Mean tumor size was 10.6 cm (3∼22). Mean liver parenchymal transection time was 20 min (15∼30). Right side hepatectomy was performed in 44 patients; left side hepatectomy with or without caudate lobe was performed in 19 patients. Twenty patients (31.3%) required blood transfusion during surgery. There was no in-hospital mortality or major complications. Minor complications developed in 6 patients (9.37%). Conclusion: GPTM and LHM are a safe and useful surgical application of various anatomical resections for huge liver tumor and an effective procedure during left hepatectomy with or without caudate lobe. (J Korean Surg Soc 2010;79:122-129)