OBJECTIVE. To review results of laparoscopic liver resections, particularly in those patients with hepatic malignancy and recurrent pyogenic cholangitis.

DESIGN. Retrospective analysis.

SETTING. Minimal access surgery training centre, Hong Kong.

PATIENTS. Patients with pathologies located at anterio-inferio-lateral segments (Couinaud segments 2, 3, 4b, 5, 6) for laparoscopic resection were recruited during the period 1998 to 2005. Patients were excluded from review if they had: pathologies at central locations and the superior and posterior segments (4a, 7, 8), large tumours (>5 cm in diameter), and those close to major vasculature or the liver hilum.

RESULTS. During the study period, we attempted 40 such laparoscopic liver resections, excluding marsupialisations and resections for simple liver cysts. There were 20 female and 20 male patients, with a mean age of 57 (standard deviation, 13; range, 29-81) years. All but one underwent a successful laparoscopic operation. Pathology included hepatocellular carcinoma (n=17), recurrent pyogenic cholangitis (n=14), colorectal liver metastasis (n=4), benign liver tumour (n=4), and intrahepatic cholangiocarcinoma (n=1). All except four were hand-assisted laparoscopic liver resections. The mean operating time was 169 (range, 60-290) minutes and mean blood loss amounted to 270 mL (range, 0-1000 mL). Complications occurred in eight (20%) patients, which included six wound infections, one postoperative bile leak, and two incisional hernias. There was no operative or hospital mortality. For hepatocellular carcinoma, clear resection (>10 mm) was achieved in all except five patients, and the 1-year and 2-year survival rates were 86% and 59% respectively. Favourable results were also obtained for resections in patients with recurrent pyogenic cholangitis; after a mean (standard deviation) follow-up of 29 (23) months, only one was readmitted (for cholangitis).

CONCLUSION. In appropriately selected patients, laparoscopic liver resection is feasible and safe, and achieves acceptable survival among individuals with hepatic malignancy and very favourable long-term outcomes in those with recurrent pyogenic cholangitis undergoing hand-assisted laparoscopic segmentectomy.

Key words: Carcinoma, hepatocellular; Cholangitis; Hepatectomy; Laparoscopy; Liver diseases

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OBJECTIVE. To review long-term efficacy and complications of surgical treatment of penile curvature in a Chinese population.

DESIGN. Retrospective review.

SETTING. Regional hospital, Hong Kong.

PATIENTS. Patients who underwent surgical treatment of penile curvature between January 1997 and March 2005 inclusive.

INTERVENTION. Penile curvature corrective surgery.

MAIN OUTCOME MEASURES. Penile curvature recurrence, early and late complications.

RESULTS. Of 22 patients who underwent surgical treatment of penile curvatures, 19 had congenital and three had acquired diseases. The mean angle of deformity was 52.5 (range, 20-90) degrees. Ten patients had Nesbit procedures, ten had modified Nesbit procedures, and two underwent vein grafting. Twenty patients had residual or recurrent penile curvatures at a mean follow-up of 50.9 months. Fifteen patients had less than 30 degrees curvature and five had 30 to 60 degrees curvature. Early complications included wound infection (n=3), penile skin necrosis (n=1) treated by skin graft, and urethral injury (n=1). Three patients had erectile dysfunction; four complained of glans paraesthesia. Penile shortening (mean, 1.4 cm) and palpable knots were common late complications. A total of 19 patients were satisfied with the final outcomes.

CONCLUSIONS. Surgical treatment of penile curvature produces long-term patient satisfaction. Preoperative counselling on potential recurrence and common minor complications is crucial to produce favourable outcomes.

Key words: Penile diseases; Penile induration; Surgery

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OBJECTIVE. To evaluate the medium-term results of uterine fibroid embolisation in Chinese women with symptomatic uterine fibroids.

DESIGN. Prospective case series study.

SETTING. Gynaecology and Interventional Radiology units in a public hospital, Hong Kong.

PATIENTS. Patients with symptomatic fibroids who underwent uterine fibroid embolisation in Queen Elizabeth Hospital from October 1998 to June 2004.

RESULTS. Fifty women (mean age, 42.9 years, median follow-up period, 27.5 months) were recruited. Most (82%) had menorrhagia as the chief presenting symptom. Embolisation was successful in 49 (98%) women. Complications occurred in 12 (24%) patients, but were all self-limiting. Significant decrease in the median clinical uterine size (14 weeks vs 10 weeks) and median volume of the largest fibroid on magnetic resonance imaging (157.9 mL vs 45 mL) were observed during the first year. The reduction seemed to be maintained till the last follow-up. Menorrhagia improved in 34 (84%) patients, dysmenorrhoea in 28 (88%), pelvic pain in 18 (82%) and abdominal mass in 15 (83%). Poor response was found for urinary symptoms (29% improvement). Eight (16%) patients underwent hysterectomies after uterine fibroid embolisation. On logistic regression analysis, the only significant predictive factor for symptomatic improvement was fibroid volume reduction at 6 months (P=0.03).

CONCLUSION. Uterine fibroid embolisation is an effective uterine-preserving therapy in patients with symptomatic fibroids; overall symptomatic improvement was estimated as 80%. Uterine or fibroid size reduction correlated well with clinical outcome. The impact of uterine fibroid embolisation on young women wishing to conceive is yet to be determined.

Key words: Embolization, therapeutic; Leiomyoma; Magnetic resonance imaging; Uterus; Women

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OBJECTIVE. To analyse the association between income and health-related quality of life using the Medical Outcome Study Short Form 36 (SF-36) Chinese version in Hong Kong Chinese working population.

DESIGN. Cross-sectional observation study.

SETTING. A commercial company in Hong Kong.

PARTICIPANTS. All clerical and administrative staff of a commercial company was invited to participate; 876 of the 1003 staff agreed. The subjects were categorised into three income groups according to monthly income in Hong Kong dollars (low, <=10 000; middle, >10 000-25 000; high, >25 000). The mean age of the 288 men and 588 women was 34.9 (standard deviation, 7.9; median, 34.0; range, 18-71) years.

MAIN OUTCOME MEASURES. SF-36 scores on health-related quality of life.

RESULTS. The distribution of income was 30% in high-, 54.8% in middle-, and 15.2% in low-income groups. Women had similar SF-36 scores among different income groups. In men, for most variables there was a significant positive linear correlation between income and SF-36 scores.

CONCLUSION. Low income is associated with a worse health-related quality of life in Hong Kong Chinese men.

Key words: Asian continental ancestry group; Hong Kong; Income; Quality of life

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OBJECTIVES. To determine the incidence of adverse events after ambulatory anaesthesia (postoperative nausea and vomiting, postoperative pain, difficulty in movement), and to evaluate the level of satisfaction of patients with our service.

DESIGN. Retrospective study with questionnaire survey.

SETTING. Tertiary referral centre, Hong Kong.

PARTICIPANTS. All patients whose duly completed questionnaires were available.

MAIN OUTCOME MEASURES. Incidence of adverse events and level of patient satisfaction.

RESULTS. A total of 9197 patients underwent surgery under general anaesthesia or neuraxial blockade by anaesthetists in ambulatory settings from October 1993 to December 2005: questionnaires filled out by 8231 of these patients were analysed, whereas 549 questionnaires were lost, and 417 patients could not be contacted. The response rate was 90%; 59% of the respondents were males, 50% were younger than 15 years and 5% older than 60 years. Fifty-one percent of surgery with anaesthetists' involvement was performed under general anaesthesia and 48.9% under general anaesthesia and regional blocks and 0.1% under neuraxial blockade. There were 3.3% of patients experienced postoperative nausea and vomiting, 60.2% experienced episodes of pain between the time of discharge and the time of interview, and 46% required analgesics. Nonetheless, 80% resumed normal activities within 5 hours after anaesthesia and 97.5% resumed normal diet the following morning. Over 99% rated our service as good or excellent.

CONCLUSION. Although ambulatory anaesthesia was associated with minor adverse events, patients could resume normal diet and daily activities quickly and were satisfied with the service.

Key words: Ambulatory care; Ambulatory surgical procedures; Anesthesia; Postoperative nausea and vomiting

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