Biomedical subjects

Wei-Jei Lee

Publications and source records attributed to Wei-Jei Lee.

42 records · Page 3Linked to original sources

PubMed2002

Comparison of open and laparoscopic antireflux surgery for the treatment of gastroesophageal reflux disease in Taiwanese.

BACKGROUND AND PURPOSE: Laparoscopic antireflux surgery has recently been introduced as an alternative to laparotomy for the treatment of gastroesophageal reflux disease (GERD) at National Taiwan University Hospital. This study compared the results of traditional open and laparoscopic fundoplication for the treatment of GERD. MATERIALS AND METHODS: The surgical records and medical charts of 29 adult patients who were surgically treated for GERD between 1980 and 2001 were retrospectively reviewed. The clinical characteristics, indications for surgery, and surgical findings and procedures were analyzed. RESULTS: Laparotomy and Nissen fundoplication were carried out on 20 of the patients between 1985 and 2000. Laparoscopic Nissen or Toupet fundoplication was performed on nine patients between 1997 and 2001. Patients in the laparoscopic group were younger than those in the laparotomy group (46.7 +/- 15.9 vs 58.3 +/- 18.5 yr). The incidence of associated prominent hiatal hernia was significantly higher in the laparotomy group (60 vs 33%). The mean operation time was 164.5 +/- 25.5 minutes in the laparotomy group and 182.2 +/- 52.2 minutes in the laparoscopy group (p = 0.6129). The mean hospital stay in the laparotomy group was significantly longer than that in the laparoscopy group (8.7 vs 3.4 days). Postoperative complications included three ventral hernias and one ileus in the laparotomy group. Results were good or excellent in 78.9% (15/19) of patients undergoing laparotomy (one patient was lost to follow-up 2 months later), and in 77.7% (7/9) of those undergoing laparoscopy. Symptomatic and endoscopic recurrence was recorded in two patients in the laparotomy group and one in the laparoscopy group. CONCLUSION: Laparoscopic fundoplication is as effective as traditional laparotomy for treating GERD. More GERD patients in Taiwan, even the young and those without associated hiatal hernia, would rather undergo the less invasive and cosmetically better laparoscopic surgery than require medication throughout their lives.

Adult↗

PubMedDate not supplied

Laparoscopic mini-gastric bypass for failed vertical banded gastroplasty.

BACKGROUND: Bariatric surgery is the only method for sustained weight loss in morbid obesity. However, 10-25% of patients will require re-operation for unsatisfactory weight loss or weight regain after restrictive surgery. Re-operation is associated with higher morbidity and mortality. This study is to evaluate the s a fety and efficacy of laparoscopic mini-gastric bypass (LMGB) for failed vertical banded gastroplasty (VBG). METHODS: From May 2001 to March 2003, 29 consecutive patients underwent LMGB for failed VBG. Average age was 39.7 years (range 22 to 56), and average BMI before re-operation was 41.7 kg/m(2) (range 35.0-70.8). 8 patients had previous open VBG, and 21 had laparoscopic VBG. The re-operation was for regain of weight in 16 patients, inadequate weight loss in 10 patients, and severe reflux esophagitis in 3 patients. Re-operation was performed after an average of 58.5 months (range 14 to 180). RESULTS: All the re-operations were completed laparoscopically. Average operative time was 171.4 minutes (range 130 to 290). There was 1 mortality, due to leakage (3.4%). 1 re-operation was necessary, for incarceration of small bowel in a trocar wound 10 days after the LMGB (3.4%). 1 anastomotic site bleeding and 1 wound infection occurred. Average BMI 12 months after the LMGB was 32.1 kg/m(2) (range 26.4 to 42.7). The quality of life study was significantly improved. The revision operation had much more technical difficulty for those with previous open VBG than laparoscopic VBG. CONCLUSION: LMGB is an effective and safe revision operation for patients with failed VBG. A large series and long-term follow up is needed for confirmation.

Adult↗

PubMedDate not supplied

Bariatric surgery: Asia-Pacific perspective.

BACKGROUND: There is a world-wide epidemic of overweight, obesity and morbid obesity. Bariatric surgery today, as the only effective therapy for morbid obesity, is expanding exponentially to meet the global epidemic of morbid obesity. Bariatric surgeons in the Asia-Pacific region had founded the Asia-Pacific Bariatric Surgery Group (APBSG) at Seoul, Korea on October 6, 2004. METHODS: E-mail requests for information were sent to the national bariatric surgery leaders. These requests were followed, if necessary, by second e-mail requests and communications seeking clarification. The summary data was also discussed at the 1st Asia-Pacific Bariatric Consensus Meeting held in Taipei, February 27, 2005. RESULTS: 11 countries or areas in Asia had started bariatric surgery and responded to the general questions. In 2004, 636 bariatric operations were performed by 61 bariatric surgeons. The earliest data for starting bariatric surgery was in 1974 in Taiwan. Following the development of gastric partition, Taiwan performed the first case in 1981, Japan in 1982 and Singapore in 1987. In 2004, 11 countries have started bariatric surgery. The APBSG was founded in 2004. In 2004, 12.1% of operations were open and 87.9% laparoscopic. The 6 most popular operations were: laparoscopic adjustable banding 42.3%; laparoscopic gastric bypass 34.2%; open vertical banded gastroplasty 7.5%; laparoscopic vertical banded gastroplasty 6.3%; laparoscopic sleeve gastrectomy 6.3%; open gastric bypass 4.2%. Pooling open and laparoscopic procedures, relative percentages were gastric banding 42.3%; gastric bypass 38.4%; vertical banded gastroplasty 13.8%. The APBSG consensus meeting recommended bariatric surgery in Asian patients with BMI >37 or >32 with diabetes or two other obesity-related co-morbidities. CONCLUSIONS: Bariatric surgery is expanding rapidly in Asia to meet rapidly increasing obesity. The modification of the indications for bariatric surgery in the Asian is proposed.

Asia, Southeastern↗

PubMedDate not supplied

Alterations of BAT-26 identify a subset of gastric cancer with distinct clinicopathologic features and better postoperative prognosis.

BACKGROUND/AIMS: Gastrointestinal tumors with microsatellite instability represent a replication error-positive phenotype. BAT-26, a repeat of 26 deoxyadenosine localized in intron 5 of hMSH2 gene, has been reported as a reliable indicator of replication error phenotype in colorectal cancers. This study investigated whether BAT-26 is a useful marker for a mutator phenotype with distinct clinicopathologic features in gastric cancer. METHODOLOGY: One hundred and nineteen gastric cancer tissues and matched non-tumor tissue were examined by polymerase chain reactions with electrophoresis for 9 dinucleotide microsatellites and BAT-26, and frameshift mutations of transforming growth factor-beta type II receptor. The relation between BAT-26 alterations and relevant clinicopathological or genetic parameters were analyzed. RESULTS: Gastric cancer with BAT-26 alterations was highly correlated with multiple microsatellite alterations (> or = 3 loci) and frameshift mutations of transforming growth factor-beta type II receptor, and predominantly showed antral location, intestinal histologic subtype, advanced stage, a higher rate of Helicobacter pylori infection, a better postoperative survival and less lymph node metastasis. CONCLUSIONS: These results show testing of BAT-26 alterations is a convenient and rapid screening method for identifying a subset of gastric cancer with a mutator phenotype and better prognosis.

Adenocarcinoma↗

PubMedDate not supplied

Reappraisal of the new UICC staging system for gastric cancer: problem in lymph node stage.

BACKGROUND/AIMS: The International Union Against Cancer (UICC) TNM staging system defined a new system for classifying gastric cancer, based on the number of metastatic nodes (1997). However, the advantage of the new system is still a matter of debate. The aim of the present study is to compare the new system with the old one (1987), which is based on the location of positive lymph nodes. METHODOLOGY: We analyzed the survival of 608 patients with curative resection of their gastric cancer. The average number of resected and involved lymph nodes for each resected patient was 31.4 and 7.7. Comparison of these two systems was carried out to determine which classification was more effective. The prognostic value of different lymph node staging systems was also analyzed. RESULTS: One hundred and thirty-five patients (22.2%) had different N classification and 109 (17.9%) had different TNM staging. There was a significant stepwise decrease of slope of survival curve for each stage, but the new system did not cleanly separate stage II with IIIa at 3 years and stage IIIb with IV at 5 years. Although different lymph node staging systems were able to predict survival, the ratio rather than the number of involved nodes had a more cleanly separated stepwise decrease of slope of survival curve. CONCLUSIONS: The new UICC staging system is not better than the old system for the staging of gastric cancer. The reason is that the category of node number seems not to be appropriate and will be influenced by the extent of lymph node dissection. To overcome this problem, the frequency of involved nodes can be adopted instead of the number.

Adenocarcinoma↗

PubMedDate not supplied

Comparison of serum CA72-4, CEA, TPA, CA19-9 and CA125 levels in gastric cancer patients and correlation with recurrence.

BACKGROUND/AIMS: Serum tumor markers were investigated as prognostic factors for recurrence in patients with gastric cancers. METHODOLOGY: Preoperative serum levels of CEA, CA72-4, CA19-9, TPA and CA125 were sampled in 196 patients with gastric cancers undergoing curative surgery. The results were compared with the clinical recurrence and various clinicopathological factors. RESULTS: CA72-4, CEA, CA19-9, TPA and CA125 had sensitivities of 16.4%, 31.4%, 16.1%, 31.6%, and 6%, respectively. Sensitivity of two combinations was as high as 56.5%. Seventy-seven patients (39.9%) had clinical recurrence in the follow-up periods. For those with preoperatively elevated serum tumor markers, 38% (12/32) had CA72-4, 42% (13/31) had CA19-9, 48% (29/60) and had CEA, 54% (6/11) had CA125, and 62% (37/61) had TPA, and remained disease-free. Univariate analysis showed that TNM staging, Tumor size, Borrmann classification of tumor growth, and preoperative serum CA72-4 level were correlated with recurrence of disease. Multivariate analysis showed that independent prognostic factor of recurrence was TNM staging (P = 0.0007). CONCLUSIONS: Preoperative serum CA72-4 level is correlated with staging of disease, but is not an independent predictor for clinical recurrence of disease in patients with gastric cancers that undergo surgery.

Adult↗