• Journal of Chest Surgery
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• 제53권4호
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• pp.205-210
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• 2020

Esophageal anastomotic leak is the most common and serious complication following esophagectomy. However, the standard treatment for anastomotic leaks remains unclear. Recently, endoscopic vacuum therapy has become an important non-surgical alternative treatment method for patients with esophageal anastomotic leak. This treatment involves the endoscopic placement of a sponge connected to a nasogastric tube into the defect cavity or lumen. Subsequently, continuous negative pressure is delivered to the cavity through the tube. Several studies have reported a treatment success rate of 80% to 100%. In this study, we review the mechanism of action, the method of performing the procedure, its safety and efficacy, and prognostic factors for failure of endoscopic vacuum therapy in the management of patients with anastomotic leak, and on this basis attempted to confirm the possibility of establishing a standardized treatment protocol using endoscopic vacuum therapy.

• Journal of Chest Surgery
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• 제49권2호
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• pp.99-106
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• 2016

Background: Barium swallow is performed following esophagectomy to evaluate the anastomosis for detection of leaks and to assess the emptying of the gastric conduit. The aim of this study was to evaluate the reliability of the barium swallow study in diagnosing anastomotic leaks following esophagectomy. Methods: Patients who underwent esophagectomy from January 2000 to December 2013 at our institution were investigated. Barium swallow was routinely done between days 5-7 to detect a leak. These results were compared to clinically determined leaks (defined by neck wound infection requiring jejunal feeds and or parenteral nutrition) during the postoperative period. The sensitivity and specificity of barium swallow in diagnosing clinically significant anastomotic leaks was determined. Results: A total of 395 esophagectomies were performed (mean age, 62.2 years). The indications for the esophagectomy were as follows: malignancy (n=320), high-grade dysplasia (n=14), perforation (n=27), benign stricture (n=7), achalasia (n=16), and other (n=11). A variety of techniques were used including transhiatal (n=351), McKeown (n=35), and Ivor Lewis (n=9) esophagectomies. Operative mortality was 2.8% (n=11). Three hundred and sixty-eight patients (93%) underwent barium swallow study after esophagectomy. Clinically significant anastomotic leak was identified in 36 patients (9.8%). Barium swallow was able to detect only 13/36 clinically significant leaks. The sensitivity of the swallow in diagnosing a leak was 36% and specificity was 97%. The positive and negative predictive values of barium swallow study in detecting leaks were 59% and 93%, respectively. Conclusion: Barium swallow is an insensitive but specific test for detecting leaks at the cervical anastomotic site after esophagectomy.

• Journal of Chest Surgery
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• 제31권1호
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• pp.77-81
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• 1998

장관의 문합부전에 대하여 장관내 삽관이 치료에 도움이 될 수 있을 것으라고 생각되고 있으나, 이에 대한 보고는 찾아보기 드물다. 저자들은 식도와 위의 중복암 환자에서 식도-공장 문합술후에 발생한 문합부전에 대하여 식도내 삽관으로 매우 효과적이고 빠른 호전을 경험하였다. 식도내 삽관은 술후 제28병일에 시행하였으며, 삽입후 약 3주후부터 문합부 유출 및 염증소견들이 소실되었다. 수술후 약 11개월이 경과한 현재, 삽관은 약 1 cm 가량 하방으로 이동되어 있으나 더 이상의 변화는 없으며, 환자는 고형식사을 지속하고 있다. 따라서 저자들은 장문합부전의 제한된 경우에 있어서는 장관내 삽관이 도움을 줄 수 있을 것이라고 생각한다.

• 대한영상의학회지
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• 제85권3호
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• pp.668-675
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• 2024

대동맥 문합부 누출은 급성 대동맥 박리의 치료인 상행 대동맥 치환술 후 발생할 수 있는 흔하지 않은 합병증이다. 대동맥 문합부 누출의 치료로는 재수술이 전통적인 치료 방법으로 추천되나 높은 사망률과 이환율을 보인다. 최근에는 몇 건의 증례 보고에서 중재 시술이 대안적인 접근방식으로 시도되고 있다. 이에 저자들은 A형 대동맥박리의 치료인 대동맥 이식편치환술 후 봉합선 열개에 의한 대동맥 문합부 누출을 코일과 N-butyl cyanoacrylate로 색전술을 시행한 증례와 혈관마개로 성공적으로 치료한 증례를 보고하고자 한다.

• Journal of Chest Surgery
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• 제27권2호
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• pp.153-156
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• 1994

Bentall`s operation for repair of annuloaortic ectasia has been associated with postoperative bleeding and with false aneurysm of the anastomotic site between the coronary orifice and composite graft.Among 5 cases, 2 cases have been operated direct anastomosis between coronary artery and vascular graft.Remained 3 cases have been operated with doughnutlike Teflon felt buttress.The technique of sandwiching the freed button of aortic wall bearing the coronary artery ostium between an outer Teflon felt doughnutlike buttress and the inner composite graft provides a leak-proof anastomosis.We experienced one case reoperation for bleeding at coronary anastomotic site above method.

• Journal of Gastric Cancer
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• 제15권3호
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• pp.167-175
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• 2015

Purpose: Although several studies report risk factors for anastomotic leakage after gastrectomy for gastric cancer, they have yielded conflicting results. The present retrospective cohort study was performed to identify risk factors that are consistently associated with anastomotic leakage after gastrectomy for stomach cancer. Materials and Methods: All consecutive patients who underwent gastrectomy at a single gastric surgical unit between May 2003 and December 2012 were identified retrospectively. The associations between anastomotic leakage and 23 variables related to patient history, diagnosis, and surgery were assessed and analyzed with logistic regression. Results: In total, 3,827 patients were included. The rate of anastomotic leakage was 1.88% (72/3,827). Multiple regression analysis showed that male sex (P=0.001), preoperative/intraoperative transfusion (P<0.001), presence of cardiovascular disease (P=0.023), and tumor location (P<0.001) were predictive of anastomotic leakage. Patients with and without leakage did not differ significantly in terms of their 5-year survival: 97.6 vs. 109.5 months (P=0.076). Conclusions: Male sex, cardiovascular disease, perioperative transfusion, and tumor location in the upper third of the stomach were associated with an increased risk of anastomotic leakage. Although several studies have reported that an anastomotic complication has a negative impact on long-term survival, this association was not observed in the present study.

• Journal of Chest Surgery
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• 제16권4호
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• pp.584-593
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• 1983

Esophageal reconstruction was performed in 344 patients with irreversible stricture of the esophagus resulting from caustic burns at National Medical Center from 1959 to 1982.There were 113 males and 231 females, and ranging from 2.5 to 58 years of age, and mean age was 26.5 years, and 25 cases were less than 10 years old. Caustic materials were 286 [83.2%] alkali and 50[14.5%] acid. The most frequent stricture site was upper thoracic esophagus as 56.7%, and the next was cervical as 31.4%, and lower, 11.9%. The stomach was involved in 10.8% totally, and hypopharyngeal stricture was also noticed in 3.2%, and in 3 cases, hypopharyngeal reconstruction was needed due to extensive scar change. In 329 of total 344 cases, colon interposition was performed without resection of the strictured esophagus except 4 cases which were complicated T-E fistula or perforation, and most of them, about 10-15 cm of terminal ileum with right half of the colon was used as the graft. The left colon with anti-peristalsis was used as graft only in 30 cases. The most common postoperative complication was anastomotic leak as 16.7% of total cases, and it was 12.5% from neck, 3.3% from ileocolostoma and 0.9% from cologastrostoma. Next common complication was neck stenosis [8.8%], aspiration pneumonia [6.4%], and graft necrosis [3.9%] in order. Overall operative mortality was 5.5% [14/329], and main causes of death were graft necrosis, sepsis due to anastomotic leak, gastric bleeding, and intestinal obstruction. Besides of colon interposition, according to shape or level of the stricture, plastic repair or segmental resection and direct anastomosis was done in 9, and 1 of them were complicated stenosis at the anastomotic site. In lower stricture, esophagogastrostomy was done in 10 cases, and 1 case expired due to hepatitis, and anastomotic stenosis was occurred in 2 cases at 1.5 months and 2.4 years later. During follow-up of 298 cases colon interposition from 6 months to 22 years, 82.6% was excellent, and 2.9% was complained of mild discomfort, and 4 cases were dead laterly, but 3 of them were not related to reconstruction.

• Journal of Gastric Cancer
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• 제24권1호
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• pp.108-121
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• 2024

Anastomotic leaks and fistulas are significant complications of gastric surgery that potentially lead to increased postoperative morbidity and mortality. Surgical intervention is reserved for cases with severe symptoms or hemodynamic instability; however, surgery carries a higher risk of complications. With advancements in endoscopic treatment options, endoscopic approaches have emerged as the primary choice for managing these complications. Endoscopic clipping is a traditional method comprising 2 main categories: through-the-scope clips and over-the-scope clips. Through-the-scope clips are user friendly and adaptable to various clinical scenarios, whereas over-the-scope clips can close larger defects. Another promising approach is endoscopic stent insertion, which has shown a high success rate for leak closure, although vigilant monitoring is required to monitor stent migration. Infection control is essential in post-surgical leakage cases, and endoscopic internal drainage provides a relatively safe and noninvasive means to manage fluids, contributing to infection control and wound healing promotion. Endoscopic suturing offers full-thickness wound closure, but requires additional training and endoscopic versatility. As a promising tool, endoscopic vacuum therapy potentially surpasses stent therapy by draining inflammatory materials and closing defects. Furthermore, the use of tissue sealants, such as fibrin glue and cyanoacrylate, has been reported to be effective in selected situations. The choice of endoscopic device should be tailored to individual cases and specific patient conditions, with careful consideration of the nature of the defect. Further extensive studies involving larger patient populations are required to provide more robust evidence on the efficacy of endoscopic approach in managing post-gastric anastomotic leaks.

• Journal of Chest Surgery
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• 제32권9호
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• pp.799-805
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• 1999

배경: 식도 및 분문부암에서 식도절제를 시행한 후 문합부에 생길 수 있는 중대한 합병증으로는 문합부 누출, 양성 협착, 그리고 종양재발 등을 들 수 있고 이러한 술후 합병증의 발생 빈도는 그 문합의 위치가 경부 또는 흉부 어디인가에 따라 달라질 수 있으므로 문합의 위치에 따른 합병증을 서로 비교할 필요가 있다. 대상 및 방법: 1987년부터 1998년까지 식도암 근치술을 시행 받은 36명의 환자를 대상으로 흉부절개에 의한 식도절제 후 그 문합 위치에 따라 경부 문합군(NA군, 20명) 및 흉부 문합군(C군, 16명)으로 각각 구분하여 비교하였다. 식도암환자의 병기는 2A기 13명, 2B기 7명, 3기 16명으로 술후 각각 판정되었고, 종양의 위치별로는 중흉부에 22명, 하흉부 및 분문부에 14명이 각각 위치하였다. 결과: 전체 수술사망률은 8.3%(경부 문합군 5%, 흉부 문합군 12.5%)였다. 문합부 누출율은 경부 문합군 15.0%, 흉부 문합군 12.5%으로 문합위치에 따른 차이는 없었으나, 문합 방법상 수봉합(27.3%)과 staple봉합(8.0%)에 따른 차이는 있었다(p＜0.05). 종양으로부터 근위부 절제연은 평균 9.6 cm(경부문합군) 및 5.8 cm(흉부문합군)였고, 문합부 종양 재발율은 5.3%(경부문합군) 및 28.6%(흉부문합군) (p＜0.05)였다. 양성 협착률-중등도 이상의 연하장해로 정의함-은 흉부문합군(21.4%)에 비해 경부문합군 (36.8%)에서 보다 높게 나타났고, 특히 staple봉합법에 의한 문합시에는 staple의 크기가 작을수록 협착의 빈도는 높았다(25-mm staple에서 41.7%, 28-mm에서 9.1%) (p＜0.05). 결론: 근위부 절제연을 크게 할수록 문합부의 종양 재발율을 줄일 수 있었고 staple봉합의 도입후 문합부 누출율은 크게 감소하였다. 양성 협착률은 경부 문합후 상대적으로 높았지만 작은(25-mm) sstaple이 사용과 술후 문합부 누출의 합병이 중등도 이상의 협착의 더욱 큰 위험 요소라고 사료된다.

• Journal of Chest Surgery
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• 제23권2호
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• pp.309-315
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• 1990

The introduction of end-to-end anastomosis stapler [EEA stapler] into esophageal surgery has reduced the mortality and morbidity associated with esophageal resection mainly owing to a reduction in the incidence of accidence of anastomotic leak. We now report the results of the 37 patients undergoing esophagectomy or esophagogastrectomy with EEA stapler in the department of cardiothoracic Surgery, Kosin Medical Center No leakage was demonstrated in the 37 esophagogastric anastomotic sites, but dehiscence of the TA stapled gastrotomy suture line occurred in two patient One patient was recovered with conservative treatment but the other patient was died due to hepatic metastasis of esophageal carcinoma during conservative treatment. And one severe esophagogastric anastomotic stricture was developed at the 30th postoperative day, but improved after dilatation with balloon dilatation catheter of Swiss Med. Tech. Company. The other complications were postoperative pneumonia[1 case], wound disruption and infection[3 cases], but all of 4 patients were recovered with conservative treatment. We experienced relative good postoperative results with use of EEA stapler in esophageal surgery. On the basis of our experience, we believe that the EEA stapler has definite place in esophageal surgery.