• Journal of Gastric Cancer
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• 제2권1호
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• pp.29-32
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• 2002

A gastroduodenostomy is the most physiological reconstruction after a distal gastrectomy. However, a gastroduodenostomy with either sutures or staples has many complications. These include bleeding, leakage and stenosis. A sutureless gastroduodenostomy with a biofragmentable anastomosis ring (BAR) in was used adenocarcinoma patients to prevent these complications from 1999. A BAR is composed of polyglycolic acid and Barium sulfate to allow for X-ray visualization. Hardy in first introduced the BAR in 1985. Since then, it has been used in an anastomosis of the colon or small bowel surgery but its use in a gastroduodenostomy is the first trial in the world. A 70 year male patient, old who received a subtotal gastrectomy (Billroth I), underwent a A sutureless gastroduodenostomy with a BAR. The gastroduodenostomy with the BAR was watertight and maintained the initial burst strength in the gastrografin X-ray study performed at the postoperative 1 week. The BAR began to fragment 3 weeks after the operation and disappeared from the digestive tract completely. The diameter of the anastomosis site was sufficient for passed foods. No other secondary changes from remained foreign bodies were found in the endoscopic examination. In a second operation to treat a primary hepatoma, there was no adhesive changes around the gastroduodenostomy site. In conclusion, a sutureless gastroduodenostomy with BAR is a safe, easy and efficient reconstructive method after a distal gastrectomy.

• 대한기관식도과학회지
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• 제4권1호
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• pp.27-34
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• 1998

Despite improvement in respiratory care, including use of low pressure and high volume cuffed tubes, tracheal stenosis remains a serious complication after a long-term tracheal intubation and tracheostomy. In such patients, tracheal resection and primary anastomosis is still considered ideal therapeutic modality. Between 1989 and 1997, we performed tracheal resections with end-to-end anastomosis on 14 patients with no operative mortality and some morbidity. Tracheal stenosis was caused by tracheostomy in nine patients, by endotracheal intubation in three patients and by thyroid carcinoma in two patients. The length of stenosis was various from 2cm to 4.5cm. All patient underwent segmental tracheal resection and primary anastomosis(14 patients) and additional procedures were cricoid cartilage reconstruction(2 patients), suprahyoid laryngeal release(3patients), carinal release technique(2 patients) and arytenoidectomy(2 patients). We have nine complications: granulona at anastomosis site in four patients, vocal cord palsy in two patients and restenosis, pneumonia, skin necrosis in each of those patients. The granuloma was removed by bronchoscopic forceps(4 patients). Vocal cord palsy was treated by arytenoidectorny(2 patients), restenosis by T-tube insertion, pneumonia by antibiotics and skin necrosis was treated by skin graft. We reviews our expenence of clinical features of tracheal stenosis and surgical treatment by tracheal one-to-end anastomosis with additional procedures to avoid postoperative complications for sucessful results.

• Journal of Gastric Cancer
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• 제4권4호
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• pp.252-256
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• 2004

목적: 최근 자동단단문합기를 이용한 위전절제술의 비율이 높아가고 있으나 술 후 식도공장문합부 협착의 발생을 현저히 감소시키지는 않는 것으로 보고 되고 있다. 이에 저자들은 자동단단문합기 사용과 식도공장문합부 협착 발생의 상관관계를 알아보기 위해 본 연구를 시작하였다. 방법: 1998년 9월부터 2000년 12월까지 만 2년 3개월 동안 인제의대 서울 백병원 한국위암센터에서 자동단단문합기를 사용하여 위전절제술을 시행 받은 환자 228예를 대상으로 연령 및 성별, 수술방법, 자동 단단 문합기의 지경과 그에 따른 수술 후 협착의 발생여부, 그리고 역류성 식도엽의 동반여부를 조사하였다. 결과: 전체 228예의 환자의 연령은 60대가 64예로 가장 많았고 다음으로 50대와 40대 순이었다. 남녀성비는 2.3:1로 남자에서 많았다. 문합부 협착이 있었던 32예 모두는 looptlr 문합술을 시행한 경우에 발생하였고 Roux-en-Y 문합술을 사용한 경우에는 발생하지 않았다. 전체 228예 중 32예($14\%$)서 협착이 발생하였으며 자동단단문합기 25mm에서는 69예 중 11예($15.9\%$), 28 mm에서는 159예 중 21예($13.2\%$)에서 발생하여 두 군간 차이는 없는 것으로 나타났다(P>0.05). 역류성 식도염은 228예 중 56예에서 발생하였으며, 이 중 7예($12.5\%$)에서 협착이 발생하였고, 역류성 식도염이 없었던 172예 중 25예($14.5\%$)에서 협착이 발생해, 두 군 간에 차이를 보이지 않았다(P>0.05). 협착의 발생시기는 6개월까지 16예, 이중 역류성 식도염이 동반된 경우는 4예($25\%$)이었으며 7개월에서 18개월까지는 14예, 역류성 식도염이 동반된 경우는 3예($21.4\%$), 19개월 이후에는 2예가 발생하여 위-식도 문합부 협착과 발생시기 또는 역류성 식도염과는 상관관계가 없었다(P>0.05). 결론: 위전절제술후에 발생하는 식도공장문합부 협착의 발생은 식도공장문합술식, 자동단단문합기의 크기, 그리고 역류성 식고염과는 상관이 없는 것으로 나타났고, 식도 공장문합부는 협착을 예방하거나 감소시키기 위해서 저자들은 적절한 크기의 자동단단문합기를 사용하여 문합부 긴장의 감소와 충분한 혈류의 공급을 유도하는 것이 중요하다고 생각한다.

• 한국임상수의학회지
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• 제18권2호
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• pp.124-132
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• 2001

The purpose of this study is to know whether single layer continuous connell suture is an acceptable alternative to simple interrupted approximating suture for end-to-end intestinal anastomosis in dogs. Fourteen mixed-breed dogs weighing 2 to 5 kg were allotted to group treated with simple interrupted approximating suture (Group I) and group treated with single layer continuous Connell suture (Group II), each of 7 dogs. All dogs in each suture pattern were compared with time for total operation ad suture elapsed for intestines to anastomose, clinical signs, changing of pre-and postoperative luminal size, status of feces, adhesion at anastomotic site for 14 days after operation. Time for total operation and suture time for intestinal anastomosis were none significant between Group I and Group II, although those in Group II was about 3 minutes shorter than those in Group I, respectively. Group I spent average 47.08${\pm}$11.10 minutes on total operation, 20.97${\pm}$5.54 minutes on suture time for intestinal anastomosis and Group II spent average 44.74${\pm}$7.77 minutes, 17.73${\pm}$3.05 minutes, respectively. All dogs were no special differences in vitality, vomiting, appetite between Group I and Group II for 14 days after operation. All dogs, except one dog in Group I, had showed normal vitality and appetite since 6~8 days after operation. Initial return of fecal passage showed in all dogs before 6 days after operation and thereafter most dogs showed normal feces. According to results, it was thought that all dogs with normal vitality and appetite before 8 days had showed good prognosis. There were no changes of intestinal luminal size in 2 dogs performed Group In and one dog performed Group II between at operation and 14 days after operation. Narrowing rate of intestinal lumen in Group I was average 9.3% of the normal diameter, whereas in Group II, 9.5% of normal diameter. In complications after operation, only one dog in Group I showed intestinal intussusception but the others didn't. Length of adhesion was measured between intestinal anastomotic site and omental graft. Length of adhesion in dogs performed Group II was mostly shorter than that of Group I. Adhesion with proximate intestines occurred in five dogs, which consisted of 3 dogs performed Group I and 2 dogs performed Group II. Concurrently, they had a great length of adhesion between anastomotic site and omental graft. There were no great differences between Group I and Group II about speed of operation, clinical signs, complications such as leakage and stricture. And all dogs performed intestinal anastomosis showed good clinical condition and prognosis. In conclusion, Single layer continuous Connell suture can safely perform an intestinal anastomosis and be an alternative of simple interrupted approximating suture in aspect of speed clinically.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권2호
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• pp.117-128
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• 2006

Free flap transplantation with microvascular anastomosis has been successfully performed by development of surgical technique, materials and postoperative monitoring equipments of flap. But success rate of microvascular anastomosis is influenced by various factors, and failure rate is about 5-10%. The most influential factor for success rate is surgical technique and other factors that influence failure of microvascular anastomosis are ischemic time of free flap, thrombus formation of anastomosis region and vascular spasm. Many studies has been published in microvascular anastomosis with histologic effect for irrigating solution. But local irrigation solution has been used clinically in microvascular anastomosis, the comparison with each solution, microhistological study for endothelial cell repair and vascular patency has not been reported. The heparin which is anti-thrombotic agent, and urokinase which is fibrinolytic agent are used for this study. Vascular patency and thrombus formation in experimental micro-arterial anastomosis, and endothelial repair were observed with histologic analysis, scanning electron microscopy, transmission electron microscopic examination. The results were obtained as follows: 1. In vascular patency test in 30 minute and 7 days after micro-arterial anastomosis, equal effects of good vascular patency were obtained in group of local irrigation with heparin and urokinase. 2. In thrombus formation in 7 days after micro-arterial anastomosis, equal effects of minimal thrombus formation were obtained in group of local irrigation with heparin and urokinase. 3. In toluidin blue staining in 7 days after micro-arterial anastomosis, local destruction of endothelial cell and inner elastic lamina were seen and endothelial repair was not seen. 4. In scanning electron microscope examination in 7 days after micro-arterial anastomosis, endothelial cell was not seen in peripheral to suture materials, thrombus associated fibrin network was observed. 5. In transmission electron microscope examination in 7 days after micro-arterial anastomosis, inflammatory cell was seen within smooth muscle cells in site of endothelial cell destruction, smooth muscle cell around suture material were arranged irregularly, some collagenous change were seen. From the results obtained in this study, same results of good vascular patency and anti-thrombotic effect of heparin and urokinase were obtained as a local irrigation solution, and repair of endothelial cell was not seen in 7 days after micro-arterial anastomosis.

• Journal of Chest Surgery
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• 제33권8호
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• pp.676-680
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• 2000

To minimize the period of brain ischemia and the potential for neurologic damage during aortic arch replacement, we used the arch-first technique. First case was a 28-year-old female with extensive aneurysm involving ascending, arch and descending thoracic aorta. Exposure was obtained via a bilateral via a bilateral thoracotomy (clamshell incision) in the anterior 4th right and 3rd left intercostal space with oblique sternotomy. To prepare for arch perfusion, the side-arm graft(10mm) was anastomosed to the aortic graft, opposite the site of the planned anastomosis to the arch vessels. After completing the arch anastomosis under total circulatory arrest(37min) and retrograde cerebral perfusion(12min), aortic graft was clamped on either side and the arch was perfused via side-arm graft for 36min. When distal aortic anastomosis was finished, distal clamp of aortic graft was released and arch vessels were perfused via common femoral artery, and the proximal aortic anastomosis was accomplished. The patient was discharged with no event. Second case was a 48-year-old male with extensive aneurysm involving ascending, arch, and aortic regurgitaiton(grade III/IV). This case was also done using the clamshell incision. Aortic valve replacement was done by valved-conduit(Vascutek 30mm), both coronary artery anastomosis using Cabrol's procedure. Last operation procedure was the same as the 1st case.

• Journal of Chest Surgery
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• 제24권8호
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• pp.765-772
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• 1991

Between 1985 and 1990, 41 patients underwent treatment of the tracheal stenosis. Nineteen patients underwent resection and end-to-end anastomosis including three cases of the subglottic stenosis. Other patients had had treatment such as LASER therapy, bronchoscopic removal, insertion of the Montgomery silastic T-tube or stent insertion Nineteen patients which underwent resection and end-to-end anastomosis were excellent result from three years to sixth months. Other patient were followed at OPD for the other complication or restenosis. There were no hospital death but one patient was managed by bronchoscopic removal of the granulation tissue and other one patient had underwent reoperation for the dehiscence at the anastomotic site.

• Archives of Reconstructive Microsurgery
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• 제13권2호
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• pp.101-106
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• 2004

Purpose : This study evaluated the effect of VEGF in the arterial anastomosis by using light and electron microscopy. Marerials and method : Rats underwent femoral arterial end-to-end anastomosis after transection and topical VEGF treatment. The proximal and distal segments of the femoral arteries was drenched with 1 drop of VEGF $(100ng/100{\mu}l/bottle)$. and when half of the repair was finished, the other 1 drop was drenched and then the repair was continued to complete the anastomosis. Gross and histologic characteristics of arterial wall were assessed after 3 days, 1, 3 and 5 weeks. In the control group, normal saline solution instead of VEGF was dropped with the same method in the anastomosis. Results : The histologic findings of the arterial wall were the vascular remodeling with the infiltration of inflammatory cells at early stages and the tissue fibrosis at lately stages in the anastomotic sites of the control and the VEGF-treated groups. The scanning electron microscopic results were; (1) the anastomotic sites were covered by many irregular cells with long cytoplasmic processes at the early stages. (2) After 1 week, endothelial cells started to cover the anastomotic sites. (3) After 3 weeks, the anastomotic sites were partially covered by endothelial cells in the control group. (4) After 5 weeks, the anastomotic sites were completely covered by endothelial cells in the control and VEGF-treated groups. (5) In the VEGF-treated group, the anastomotic site was completely covered by endothelial cells which directed parallel to longitudinal axis of arteries after 3 weeks. Conclusion : Topical VEGF maintained luminal integrity by decreasing fibrosis and increasing re-endothelialization. These findings suggest that topical VEGF may be a promising new strategy to enhance healing and improve the outcome of vascular anastomosis.

• Bulletin of the Korean Chemical Society
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• 제34권6호
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• pp.1663-1667
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• 2013

Neointimal hyperplasia causes vascular access dysfunction in hemodialysis patients with synthetic arteriovenous (AV) grafts. Several studies have reported that paclitaxel- or sirolimus-eluting AV grafts inhibit neointimal hyperplasia and display lower rates of stenosis compared with control grafts. However, there have been few comparative studies of the efficacy of paclitaxel- and sirolimus-eluting grafts. We compared the neointimal hyperplasia of paclitaxel- and sirolimus-eluting grafts. AV grafts were implanted laterally between the common carotid artery and the external jugular vein in 12 female Landrace pigs. The animals were sacrificed six weeks after surgery. The neointimal hyperplasia at the anastomosis sites of the grafts was quantified using the ratio of the intragraft hyperplasia to the graft area (H/G ratio) at the graft-vessel interface. The area of intimal hyperplasia at the venous (paclitaxel 1.06 [0.72-1.56] vs sirolimus 2.40 [1.72-3.0] $mm^2$, P = 0.04) and arterial anastomosis sites (paclitaxel 0.93 [0.57-1.48] vs sirolimus 2.40 [1.72-3.0] $mm^2$, P = 0.04) was significantly different between the two groups. However, the H/G ratios for the venous anastomosis site (paclitaxel 0.25 (0.17-0.38) vs sirolimus 0.38 (0.2-0.66), P = 0.4) and the arterial anastomosis site (paclitaxel 0.19 (0.08-0.39) vs sirolimus 0.41 (0.34-0.50), P = 0.1) did not differ significantly between the groups. In conclusion, there was no significant difference in the inhibition of neointimal hyperplasia by sirolimus- and paclitaxel-eluting AV grafts.

• 한국임상수의학회지
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• 제28권1호
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• pp.63-70
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• 2011

To consider the iliac fossa as the vascular anastomosis site of kidney transplantation for the short-term study of acute rejection in pigs. Twelve domestic pigs weighing 39~48 kg underwent heterotopic renal allgraft transplantation. The experimental animals were divided into 2 groups in terms of renal vascular anastomosis site; the external iliac artery and vein were used in iliac fossa model (n = 6), the abdominal aorta and the caudal vena cava inferior to the kidney were used in abdominal cavity model (n = 6). Renal function was evaluated by daily measurement of plasma creatinine and BUN concentrations. The experiments' health including postoperative complications was also assessed daily for 8 days after transplantation. After euthanazation gross and histopathologic analysis was performed. All six pigs in iliac fossa model developed neuropraxia and lameness of the ipsilateral pelvic limb. However, no necrosis was observed in any pigs. In the abdominal cavity model, durations of both the surgical operation and the vascular anastomosis were significantly longer than those in the iliac fossa model. Furthermore, ischemia injury of the transplanted kidney was increased in abdominal cavity model, which induced accelerated-acute immune response from day 4 after transplantation. Despite of pelvic limb complication, the iliac fossa model showed more advantages including not only less ischemia time related to easy vascular anastomosis, but also less immune response during the acute rejection period. The results indicate that the iliac fossa model may be appropriate to the study of acute rejection in porcine kidney transplantation.