• Asian Pacific Journal of Cancer Prevention
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• 제15권10호
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• pp.4295-4299
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• 2014

Background: Surgery offers the only potential for cure and long-term survival of recurrence of rectal cancer. Few studies about laparoscopic recurrent lesion resection have been reported. This study was designed to evaluate the safety and feasibility of laparoscopic abdomino-perineal resection for anastomotic recurrence of rectal cancer. Materials and Methods: Data for 42 patients with recurrence of rectal cancer were collected retrospectively. Of the 42 patients, 22 underwent laparoscopic surgery (LR group) and 20 received open surgery (OR group). Outcomes between the two groups were compared. Results: Operation time in LR group was shorter compared with the OR group ($164.6{\pm}27.7min$ vs $203.0{\pm}45.3min$); intra-operative blood loss was $119.7{\pm}44.4ml$ and $185.0{\cdot}94.0ml$ in LR group and OR group, respectively (p<0.001); time to first flatus in LR group was shorter than in OR group, and the difference was statistically significant ($2.6{\pm}0.8$ days vs $3.1{\pm}0.8$ days, p=0.013); hospital stay in the LR and OR groups was $8.6{\pm}1.3$ days and $9.8{\pm}2.2$ days; 3-year survival rates in the LR and OR groups were 44.4% and 42.8% (p=0.915) and the 3-year disease-free survival rates were 36.4% and 30.0%, respectively (p=0.737). Conclusions: Laparoscopic abdomino-perineal resection is safe and feasible for anastomotic recurrence of rectal cancer.

• Journal of Gastric Cancer
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• 제9권4호
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• pp.223-230
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• 2009

목적: 원형문합기를 이용한 기계 문합술은 여러 가지 장점들로 인해 선호도가 증가하는 반면 수술 후 합병증 또한 지적되고 있다. 이에 저자들은 원형문합기를 이용한 위공장문합술을 시행할 때 발생할 수 있는 합병증을 분석하고, 기계문합술시 합병증을 감소시킬 수 있는 보완 술식을 제시하고자 하였다. 대상 및 방법: 1998년 1월부터 2007년 12월까지 순천향대학교 의과대학 외과학교실에서 근치적 위아전절제술 후 위공장문합술을 시행한 1,391명을 대상으로 하였으며, 수기 문합군을 I군, 선형문합기군을 II군, 원형문합기군을 III군으로 하였다. III군은 수술 중 직접 육안으로 출혈여부를 확인 했던 2001년 1월을 기점으로 III-A군, III-B군으로 세분하였으며, 임상적 특징과 문합부와 관련된 수술 후 합병증을 비교분석하였다. 결과: 문합부 누출은 I군에서 7예(1.5%), II군에서 1예(2.0%), III군에서 10예(1.2%)가 발생하였고, 문합부 협착은 I군에서 4예(0.8%), II군에서 1예(2.0%), III군에서 5예(0.6%)가 발생하였다. 문합부 출혈은 I군에서 32예(6.7%), II군에서 5예(10.4%), III군에서 67예(7.7%)가 발생하였으며, III-A군에서는 57예 (28.8%), III-B군에서는 10예(1.5%)가 발생하여 두 군 간에 통계적으로 유의한 차이가 있었다(P=0.037). 결론: 위아전절제술 후 원형문합기를 이용한 위공장문합술은 간편하고 안전하며 효율적인 술식이나 수술 시 세심한 주의가 요구되며, 문합부의 출혈 유무를 술 중 육안적으로 확인한 후 수술을 종료하는 보완된 술식으로 문합부출혈을 예방함으로써 기계문합법의 안전성이 더욱 향상될 것이다.

• Archives of Reconstructive Microsurgery
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• 제8권1호
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• pp.22-27
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• 1999

While the conventional end-to-end anastomotic technique is accepted as 'the golden standard' for microvascular anastomosis, it is time-consuming and tedious. In an effort to offer faster and safer ways of performing microvascular anastomoses, numerous anastomotic techniques have been proposed, but further refinements in microvascular techniques are still necessary. A 'continuous suture with interrupted knot' technique was devised for faster and safer anastomosis. It has been successfully used in microanastomoses of both artery and vein for free tissue transfer. It is a combination of the interrupted suturing technique and the continuous suturing technique. First, a continuous suture is made with the size of loop decreasing in order, and then the sutures are tied individually from the first loop to the last one as in the conventional interrupted suturing technique. It was applied clinically to fourteen patients over the past ten months and found to be a highly efficient technique that satisfied our needs. This 'continuous suture with interrupted knot' technique has several advantages over other techniques : The operative time is reduced comparing conventional interrupted suture technique. By delaying the tie and with the vessel walls kept separated, the risk of through-stitch can be reduced. Tying all the sutures at one time not only speed up the procedures, but also reduced the surgeon's fatigue. In addition, it has no problem of anastomotic stenosis which is a disadvantage of continuous suture technique. This technique proved to be faster and safer, and has patency equal to that of the conventional end-to-end anastomosis. It is of great help to the surgeon in reducing operative time, especially in clinical situations when many anastomoses are required, or lengthy grafting procedures are undertaken.

• Journal of Gastric Cancer
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• 제18권1호
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• pp.37-47
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• 2018

Purpose: The endoscopic management of a fully covered self-expandable metal stent (SEMS) has been suggested for the primary treatment of patients with anastomotic leaks after total gastrectomy. Embedded stents due to tissue ingrowth and migration are the main obstacles in endoscopic stent management. Materials and Methods: The effectiveness and safety of endoscopic management were evaluated for anastomotic leaks when using a benign fully covered SEMS with an anchoring thread and thick silicone covering the membrane to prevent stent embedding and migration. We retrospectively reviewed the data of 14 consecutive patients with gastric cancer and anastomotic leaks after total gastrectomy treated from January 2009 to December 2016. Results: The technical success rate of endoscopic stent replacement was 100%, and the rate of complete leaks closure was 85.7% (n=12). The mean size of leaks was 13.1 mm (range, 3-30 mm). The time interval from operation to stent replacement was 10.7 days (range, 3-35 days) and the interval from stent replacement to extraction was 32.3 days (range, 18-49 days). The complication rate was 14.1%, and included a single jejunal ulcer and delayed stricture at the site of leakage. No embedded stent or migration occurred. Two patients died due to progression of pneumonia and septic shock 2 weeks after stent replacement. Conclusions: A benign fully covered SEMS with an anchoring thread and thick membrane is an effective and safe stent in patients with anastomotic leaks after total gastrectomy. The novelty of this stent is that it provides complete prevention of stent migration and embedding, compared with conventional fully covered SEMS.

• Journal of Chest Surgery
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• 제32권10호
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• pp.924-929
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• 1999

Background: The use of the stapler n esophageal reconstruction after esophageal resection for benign or malignant esophageal diseases has become popular because it has less leakage at the anastomotic site and shorter operation time than manual sutures. However, the use of classic circular stapler has some complications such as stenosis and dysphagia that requires additional treatment. Such complications are closely related to the inner diameter of the anastomotic sites. In this study, the diameter of anastomotic site was compared after the use of circular stapler(EEA) and straight endoscopic stapler(endo GIA). Material and Method: The patients who received esophageal reconstruction by stapler from August 1995 to September 1997 were reviewed. The patients were divided into 2 groups. One group need the circular stapler, and the other group the straight endo GIA(14 cases with endo GIA 30mm, 24 with endo GIA 45mm). After a cervical esophago-enteric anastomosis, the stricture of anastomotic site and the incidence of dysphagia were compared between the 2 groups using an esophagography and the patient's symptoms. The follow-up period was 12months in average. Result: In the former group in which the circular stapler was used, 2 cases of anastomotic stenosis were reported. In comparison, none were reported in the latter group. Dysphagia were reported in 8 cases of the former group, and in 3 cases of the latter group(1 case in endo GIA 30 mm, 2 cases in endo GIA 45 mm). Conclusion: The use of endo GIA in esophago-enteric anastomosis resulted in a wider diameter of the anastomotic site, lesser stricture, and lesser incidence of dysphagia compared to the use of former circular stapler. Therefore, it is thought to be a better method in esophageal reconstructions.

• Annals of Coloproctology
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• 제34권6호
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• pp.317-321
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• 2018

Purpose: We evaluate the role of transanal tube drainage (TD) as a conservative treatment for patients with anastomotic leakage (AL). Methods: Patients treated for AL who had undergone a low or an ultralow anterior resection with colorectal or coloanal anastomosis for the treatment of rectal cancer between January 2013 and January 2017 were enrolled in this study. The data were collected prospectively and analyzed retrospectively. The primary outcomes were the diagnosis and the management of AL. Results: Two hundred thirteen consecutive patients, 122 males and 91 females, were included. The mean age was $66.91{\pm}11.15years$, and the median body mass index was $24kg/m^2$ (range, $20-35kg/m^2$). The median tumor distance from the anal verge was 8 cm (range, 4-12 cm). Ninety-three patients (44%) received neoadjuvant therapy for nodal disease and/or locally advanced rectal cancer. Only 13 patients (6%) developed AL. Six patients developed subclinical AL as they had a defunctioning ileostomy at the time of the initial procedure. They were treated conservatively with TD under endoscopic guidance in the endoscopy unit and received intravenous antibiotics. Six weeks after discharge, these 6 patients underwent follow-up flexible sigmoidoscopy which showed a completely healed anastomotic defect with no residual stenosis. Seven patients developed a clinically significant AL and required reoperation with pelvic abscess drainage and Hartmann colostomy formation. Conclusion: These results suggest that TD for management of patients with AL is safe, cheap, and effective. Salvaging the anastomosis will help decrease the need for Hartmann colostomy formation. Proper patient selection is important.

• Clinical Endoscopy
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• 제55권1호
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• pp.86-94
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• 2022

Background/Aims: The anastomotic site after distal gastrectomy is the area most affected by duodenogastric reflux. Different reconstruction methods may affect the lesion characteristics and treatment outcomes of remnant gastric cancers at the anastomotic site. We retrospectively investigated the clinicopathologic and endoscopic submucosal dissection outcomes of remnant gastric cancers at the anastomotic site. Methods: We recruited 34 consecutive patients who underwent endoscopic submucosal dissection for remnant gastric cancer at the anastomotic site after distal gastrectomy. Clinicopathology and treatment outcomes were compared between the Billroth II and nonBillroth II groups. Results: The tumor size in the Billroth II group was significantly larger than that in the non-Billroth II group (22 vs. 19 mm; p=0.048). More severe gastritis was detected endoscopically in the Billroth II group (2 vs. 1.33; p=0.0075). Moreover, operation time was longer (238 vs. 121 min; p=0.004) and the frequency of bleeding episodes was higher (7.5 vs. 3.1; p=0.014) in the Billroth II group. Conclusions: Compared to remnant gastric cancers in non-Billroth II patients, those in the Billroth II group had larger lesions with a background of severe remnant gastritis. Endoscopic submucosal dissection for remnant gastric cancers in Billroth II patients involved longer operative times and more frequent bleeding episodes than that in patients without Billroth II.

• Journal of Chest Surgery
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• 제57권2호
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• pp.152-159
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• 2024

Background: Anastomotic leakage (AL) following esophagectomy represents a serious complication that often results in prolonged hospitalization and necessitates repeated interventions, including nothing-by-mouth (NPO) restriction, endoscopic vacuum therapy (EVT), or surgical repair. In this study, we evaluated the patterns and outcomes of AL treatment. Methods: We retrospectively reviewed the medical records of patients who underwent esophagectomy for esophageal cancer at a single center between 2003 and 2020. Of 3,096 examined cases, 181 patients (5.8%) with AL were included in the study: 114 patients (63%) with cervical anastomosis (CA) and 67 (37%) with intrathoracic anastomosis (TA). Results: The incidence of AL was 11.9% in the CA and 3.2% in the TA group (p<0.001). Among patients with CA who developed AL, 87 (76.3%) were managed with NPO, 15 (13.2%) with EVT, and 12 (10.5%) with surgical repair. Over 90% of patients with cervical AL resumed an oral diet by the time of discharge, regardless of treatment method. Among patients with TA and AL, 36 (53.7%) received NPO, 25 (37.7%) underwent EVT, and 6 (9%) required surgery. Of these, 34 patients who were managed with NPO and 19 with EVT could resume an oral diet. However, only 2 patients who underwent surgery resumed an oral diet, and 2 patients required additional EVT. Conclusion: Although patients with CA displayed a higher incidence of AL, their rate of successful oral intake exceeded that of those with TA, regardless of treatment method. Among patients exhibiting AL with TA, EVT was more commonly employed than in CA cases, and it appears effective.

• 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 Chest Surgery
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• 제28권3호
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• pp.280-286
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• 1995

In our hospital we have seen 38 cases of esophageal cancer from June 1984 until June 1994. They composed of 34[89% men and 4[11% women, their age distributed from 35 to 74, mean age was 57.55 7.43. Their symptoms were varied, dysphagia[97% , pyrosis[58% , chest pain[31% , weight loss[31% , anemia[8% , vomiting[5% , and hoarseness[1% . Surgical treatment was done with esophagectomy and upper GI reconstruction 35 cases, and palliative gastrostomy was 3 cases. There was no operative mortality, and operative morbidity was 8 cases of anastomotic leakage, 5 cases of wound infection, 5 cases of pleural effusion, hoarseness, pneumothorax, and lung abscess. Pathologic lesion distribution: upper thoracic esophagus 6 cases[16% , middle thoracic esophagus 17 cases[45% , and lower thoracic esophagus 15 cases[39% . There was no statistical difference of transhiatal esophagectomy and transthoracic esophagectomy in complications and hospitalization period in this study but we proved the superiority of gastric upper GI reconstruction rather than colon upper GI reconstruction in anastomotic leakage and hospitalization period. Cumulative survival rate was 76.2% in 1 year survival, 33.9% in 3 year survival, 25.4% in 5 year survival, 12.7% in 10 year survival. There was no relationship with the time of dysphagia with survival in this study.