Hyeon Woo Bae

Background: Neuromuscular blocking agents (NMBAs) are the leading cause of perioperative anaphylaxis. In confirmed cases with limited non-cross-reactive options, safe anesthesia requires coordination and muscle relaxant-free strategies.Case: A 64-year-old woman with confirmed rocuronium-induced anaphylaxis and multiple comorbidities—including poorly controlled diabetes, coronary artery disease, chronic obstructive pulmonary disease, and obesity—underwent laparoscopic anterior resection of the sigmoid colon. General anesthesia was induced and maintained without muscle relaxants using total intravenous anesthesia and regional blocks. Airway topicalization and deep anesthesia enabled smooth intubation. Bilateral transversus abdominis plane and rectus sheath blocks provided effective somatic analgesia and abdominal relaxation. Ventilation and hemodynamic parameters remained stable throughout. The patient recovered uneventfully, without agitation or delayed arousal, and was discharged uneventfully on postoperative day 5.Conclusions: This report describes the feasibility of NMBA-free general anesthesia using intravenous agents and targeted regional blocks in high-risk patients with confirmed anaphylaxis, even in laparoscopic procedures.

Bae HW, et al. Ann Surg Treat Res. 2025 Mar;108(3):143-149. https://doi.org/10.4174/astr.2025.108.3.143

Background/Objectives: Intestinal Behçet’s disease (iBD) often requires surgical intervention, with a significant proportion of patients needing reoperation. This study aimed to investigate the risk factors associated with reoperation in patients with iBD who underwent initial bowel resection and to evaluate the perioperative and long-term outcomes in these patients. Methods: This was a retrospective case-control study analyzing patients who underwent their initial bowel resection due to iBD between 2005–2021 at a tertiary referral hospital. Reoperation was considered a surgery due to postoperative complications (within 30 days of the initial surgery) or disease progression. Results: A total of 81 patients were included. The median follow-up duration was 107.1 months, during which 26 patients (32%) underwent reoperation. Multivariable analysis showed that the presence of hematological disorders (hazards ratio [HR], 9.13; 95% confidence interval [CI], 3.79–22.02, p < 0.001), higher c-reactive protein (CRP) levels before the initial surgery (HR, 1.01; 95% CI, 1.01–1.02, p < 0.001), and a shorter specimen resection length (HR, 0.96; 95% CI, 0.93–0.99, p = 0.011) were risk factors for reoperation. Patients who underwent reoperation had higher rates of postoperative complications (69.2% vs. 43.6%, p = 0.031), required longer antibiotic use (12 vs. 7 days, p = 0.012), and had extended hospital stays (18 vs. 9 days, p = 0.011). They also had worse 5-year survival rates than those who did not undergo reoperation (83.5% vs. 98.4%, p = 0.012). Conclusions: Concurrent hematological disorders, high preoperative CRP levels, and short specimen resection were associated with an increased risk of reoperation in patients with iBD who underwent their initial bowel resections. They also had worse perioperative and long-term outcomes.

Total mesorectal excision (TME) has greatly improved rectal cancer surgery outcomes by reducing local recurrence and enhancing patient survival. This review outlines essential knowledge and techniques for performing TME. TME emphasizes the complete resection of the mesorectum along embryologic planes to minimize recurrence. Key anatomical insights include understanding the rectal proper fascia, Denonvilliers fascia, rectosacral fascia, and the pelvic autonomic nerves. Technical tips cover a step-by-step approach to pelvic dissection, the Gate approach, and tailored excision of Denonvilliers fascia, focusing on preserving pelvic autonomic nerves and ensuring negative circumferential resection margins. In Korea, TME has led to significant improvements in local recurrence rates and survival with well-adopted multidisciplinary approaches. Surgical techniques of TME have been optimized and standardized over several decades in Korea, and minimally invasive surgery for TME has been rapidly and successfully adopted. The review emphasizes the need for continuous research on tumor biology and precise surgical techniques to further improve rectal cancer management. The ultimate goal of TME is to achieve curative resection and function preservation, thereby enhancing the patient’s quality of life. Accurate TME, multidisciplinary-based neoadjuvant therapy, refined sphincter-preserving techniques, and ongoing tumor research are essential for optimal treatment outcomes.

Bae HW, et al. Yonsei Med J. 2024 Jul;65(7):380-388. https://doi.org/10.3349/ymj.2023.0279

Cho MS, et al. Yonsei Med J. 2023 Jun;64(6):395-403. https://doi.org/10.3349/ymj.2023.0042