• Journal of Chest Surgery
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• v.16 no.2
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• pp.231-242
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• 1983

A clinical study was performed on 75 cases of the esophageal cancer and benign esophageal diseases experienced at Department of thoracic & cardiovascular surgery, School of Medicine, Keimyung University during 3 year period from 1978 to 1982. Of 75 cases of the surgical esophageal diseases, there were 35 patients of the esophageal cancer. 17 patients of benign esophageal stenosis, 10 patients of esophageal perforation, 4 patients of diverticulum. 3 patients of achalasia, 2 patients of congenital T-E fistula, one of upper esophageal web, one of esophageal foreign body, one of leiomyoma and patient of hemangioma. First, esophageal carcinoma was more frequent in men than in women by a ratio of five to one, and the peak incidence occurred in the 5th to 6th decade. Dysphagia was the most common symptom in 88.6 percent of our cases. The tumor was located mostly in the middle & the lower one third [91.4%]. The histological diagnosis was made in 35 cases. The squamous cell carcinoma was the most common [82.9%] and the rest was the adenocarcinoma in the lower one third [17.1%]. Thirty-five cases were operated and resection was feasible in the twenty-five patients [71.4%] with 2 cases of hospital mortality [5.7%]. All but two of the esophageal stenosis were caused by corrosive esophagitis and ages ranged from 7 to 70 years with average age of 32 years. Corrective operations were performed on 17 patients of esophageal stenosis of whom 12 patients had esophagocologastrostomy, 3 patients esophagogastrostomy and in non-corrosive esophageal stenosis one case and esophagoplasty and another case had release of external compression. There was one complication of stenosis of the esophageal perforation were traumatic in five cases, empyema in three cases, caustics in one case and postemetic in one case. 10 patients of the esophageal perforation underwent operation: primary closure in 5 cases, two staged colon interposition in 2, esophagogastrostomy in 1 and closed thoracotomy in 2 cases There were 2 complications of leakage of anastomosis sites in postoperative period. 4 patients of traction type of diverticulum underwent diverticulectomy & 3 patients of achalasia underwent modified Heller`s operation. 2 patients of congenital esophageal atresia had distal tracheoesophageal fistula & underwent one staged operation with the results of one death caused by pneumonia. Upper esophageal web had divulsion through the esophagoscope and foreign body in upper esophagus was removed through cervical esophagotomy. One case of leiomyoma in esophagus had esophagectomy and reconstruction with right colon. And one case of hemangioma in esophagus had esophagectomy & esophagogastrostomy.

• Archives of Craniofacial Surgery
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• v.20 no.6
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• pp.416-420
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• 2019

Reconstruction method choice in recurrent head and neck cancer depends on surgical history, radiation therapy dosage, conditions of recipient vessels, and general patient condition. Furthermore, when defects are multiple or three dimensional in nature, reconstruction and flap choice aimed at rebuilding the functional structure of the head and neck are difficult. We experienced successful reconstruction of recurrent laryngeal cancer requiring reconstruction of esophageal and tracheostomy stroma defects using a chimeric two-skin anterolateral thigh flap with a single pedicle.

• Journal of Chest Surgery
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• v.28 no.11
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• pp.1032-1037
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• 1995

Between September 1988 and December 1993, 32 cases of benign esophageal stricture, of which 12 males and 20 females, were managed in Seoul National University Hospital hospital. Their age ranged from 2 to 61 years, and the mean age was 33.9 years. The ingestion of caustic agent was the most common cause, and the caustic material was acid in 16 patients [58% and alkali in 11patients [39% . Nearly all of the patients complained of dysphagia, and some of chest pain, epigastric pain, weight loss, vomiting, general malaise, and dyspnea. The most frequent site of stricture was found in the upper thoracic esophagus with 34% incidence followed by the lower thoracic esophagus[28% , whole esophagus[19% , and the mid esophagus[16% . The operations performed were 17[53% ECG[esophagocologastrostomy , 5[16% PCG[pharyngocologastrostomy , 5[16% EG[esophagogastrostomy , 2 EJG [esophagojejunogastrostormy by free jejunal graft , and 1 case each of EJ [esophagojejunostomy , esophageal end to end anastomosis, jejunostomy only, and gastrostomy only. In 23 patients [72% , diseased esophaguses were resected, using transhiatal total esophagectomy in 15 [47% and transthoracic partial esophagectomy in 8 [25% . Of those 23 patients, 3 patients [9.4% were diagnosed as esophageal carsinoma on microscopic examination. The postoperative most common complications were unilateral vocal cord palsy in 6 patients [19% , followed by cervical anastomosis leakage in 4 patients [12.5% , wound infection in 2 patients [6% , and pneumothorax in 2 patients [6% . Late death occurred 8 months after the operation in one patient, which was associated with infection due to anastomotic leakage. Our experience shows that the rate of mortality and the morbidity were low in patients receiving surgical management for esophageal stricture and that the cancer transformation rate was high. We recommend esophageal reconstruction surgery with esophagectomy [transhiatal or transthoracic for the esophageal stricture because it can avoid a chance of prevent cancer transformation.

• Journal of Chest Surgery
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• v.25 no.10
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• pp.1087-1092
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• 1992

We underwent two surgical resection of synchronous primary esophageal squamous cell carcinoma and gastric adenocarcinoma after obtaining histologic comfirmation 74-years old male pateint was recieved esophagectomy & total gastrectomy with esophagojejunostomy and 59-years old man was recieved near total esophagectomy and total gastrectomy with esophagocolo-gejunostomy. Their was no postoperative complications. The hospital day was 15 and 21 days postoperatively. All of them started oral intake at 7 days postoperatively and possible soft diet soon. We conclude that total resection of esophagus and stomach is the recommendable methods for prolong the life of double primary cancer patients of esophagus and stomach. Also, the reconstruction of the esophagus with colon or jejunal transposition is one of the recommenable procedure for curative surgical resection of double primary cancer in esophagus and stomach. And we also wish to emphasize the importance of detailed preopertive gastric examination for detect of gastric lesion and of careful intraoperative inspection of the gastric mucosa in patients with esophageal cancer whose preoperative gastric examination provide inconclusive evidence due to the severe esophageal stenosis.

• Journal of Chest Surgery
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• v.53 no.4
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• pp.217-221
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• 2020

Gastroesophageal reflux is a common problem after gastroesophageal resection and reconstruction, despite the routine prescription of proton pump inhibitors (PPIs). Resection of the lower esophageal sphincter and excision of the vagus nerve are generally thought to be the main factors that interfere with gastric motor function. However, physiological studies of reflux symptoms after esophagectomy are still lacking. Gastroesophageal reflux occurs frequently after esophagectomy, but there is no known effective method to prevent it. Therefore, in order to manage gastroesophageal reflux after esophagectomy, strict lifestyle modifications and gastric acid suppression treatment such as PPIs are needed, and further clinical studies are required.

• Journal of Chest Surgery
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• v.28 no.11
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• pp.1025-1031
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• 1995

Thirty patients who underwent esophageal resections due to esophageal carcinoma and benign strictures, and esophagovisceral anastomoses were performed by hand suture in 11 patients[Group I and by using the end to end anastomosis[EEA stapler in 19 patients[Group II . Anastomoses were performed in the thoracic cavity in 24 patients[Right 19, Left 5 and in the cervical area in 6 patients. There was one operative mortality[3.3% in a cancer patient who underwent Ivor-Lewis operation using EEA stapler. She expired on POD 38 days due to renal failure and sepsis. There were two anastomotic leakage in the sutured group and no anastomotic leakage in the stapled group. Late anastomotic strictures occurred in 10 patients[52.6% in the stapled group compared to 2 patients[18.1% in the sutured group. Most of the patients with late anastomotic strictures responded to one or two trials of TTS dilations. Using EEA stapler in performing esophagovisceral anastomosis is a safe method with acceptable range of complication rate, and total admission period after the operation for group I was 30.3 days compared to 25.4 days in group II although it had no clinical significance. The follow up was possible in 23 patients; 5 patients in group I died within mean 12.6 months and 9 patients in group II within mean 14.2 months.

• Journal of Chest Surgery
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• v.31 no.9
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• pp.911-914
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• 1998

We report our experience with 2 cases of perforation of intrathoracic stomach after Ivor Lewis operation for esophageal cancer. There was no problem in the anastomotic site, but the drainage from pleural cavity increased after oral intake. The stomach perforation was proved by rethoracotomy. The perforation site was repaired by sutures with pedicled intercostal muscle.

• Journal of Chest Surgery
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• v.34 no.11
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• pp.843-847
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• 2001

Background: Replacement of the esophagus remains a challenge for surgeons involved in esophageal disease. From 1996 to 1999, a total of 27 patients with esophageal cancer underwent free jejunal transfer(12cases) or esophagogastrostomy(15cases). To determine the results such as leakage of anastomosis site, stenosis, reflux esophagitis and operation time, respiratory complications, etc. we reviewed the 4 years experiences. Material and method: Palliative bypass surgery or esophageal prosthesis and cancers of the pharyngoesophageal or esophagogastric junction were excluded in this study. Resection was usually peformed through right thoracotomy and anastomosis was made with EEA staplers in esophagogas-trstomy. In cases of jejunal free transfer, 6cases of proximal esophagojejunostomy were stapled anastomosed and remaining 6 cases and all distal site were hand-sewn anastomosed. All reconstruction was done through posteromediastinal route. Result: There were two mortalities from thoracic esophagogastrostomy and one from jeunal free transfer. Major and minor complications(anastomosis site leakage: 3 cases, graft failure: 2cases etc) occurred in 27 cases. In 15 thoracic esophagogastrostomy cases, 11 patients had mild to moderate reflux esophagitis and 5 patients incurred stricture of the anastomosis. Operation time was about 550$\pm$280 minutes in jejunal free transfer, and about 300$\pm$ 160 minutes in esophagogastromy patients. Conclusion: Post operative reflux esophagitis and dysphagia were more frequent in Ivor-Lewis operation group than jejunal free transfer group; however, respiratory complications and operation time were significantly longer in jejunal (roe transfer group(p<0.05). To minimize the incidence of postoperative reflux esophagitis and dysphagia, patient evaluation focused on jejunal free transfer surgery is better than esophagogastrostomy followed by adequate post operative care.

• Journal of Chest Surgery
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• v.22 no.1
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• pp.134-140
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• 1989

A clinical evaluation was made on total 207 cases of corrosive esophageal stricture after ingestion of various corrosive substances and 173 cases of neoplasms in the esophagus and the cardia. The various complications associated with esophageal corrosion were observed on 28 cases [13.5%] in a total of 207 cases. Pathoanatomic findings of complication may be classified to the five category as follow; [1] stenosis in the pharynx due to adhesion of the epiglottis, [2] esophagobronchial fistula, [3] esophageal perforation with bougienation, [4] necrotic rupture of the esophagus and the stomach, and [5] so-called chronic corrosive gastritis. The comparative studies were done on a total of 165 cases of the various procedures of esophagoplasty to the reconstruction of the esophagus, which consists of antethoracal esophagoplasty with jejunum, retrosternal esophagoplasty with jejunum, retrosternal esophagoplasty with right colon, and retrosternal esophagoplasty with left colon. There is no hard and fast rule in selection of jejunum, right colon or left colon as the transplanting bowel and an operative method either antethoracal or retrosternal approach. When there was no possibility of the complication and no any defect of the anatomical states, one stage retrosternal esophagoplasty using right colon was better in various points of view. The 173 patients of the neoplasm of the esophagus consist of 28 cases of benign tumors and 145 cases of malignant tumors in the esophagus and cardia. 28 cases of benign tumors in the esophagus received the surgical treatment and they obtained with excellent results postoperatively. Of the 145 patients of esophageal carcinoma who received surgical managements, 101 cases [69.6%] were found to be operable and 44 cases [30.3%] were inoperable. Due to the various level of carcinoma in the esophagus, the following different surgical procedure was properly used case by case to get the best results in each case. Esophageal carcinoma in the upper and middle third segment received the total esophagectomy and the reconstruction of the esophagus using right colon by substernal procedure. Esophageal carcinoma in the lower third segment received an esophagojejunostomy in the mediastinum after the resection of lower third segment of the esophagus. Carcinoma in the esophago cardia and the stomach received also an esophagojejunostomy after the resection of the lower third segment of the esophagus and subtotal gastrectomy. For the 44 patients with inoperable carcinoma, the several palliative surgical managements such as gastrostomy or jejunostomy for feeding and esophagojejunostomy for bypass of the lower esophagus and the stomach were properly performed case by case for their maximum improvement.

• Journal of the Korean Society of Visualization
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• v.7 no.2
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• pp.22-27
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• 2010

The delayed gastric emptying flows have been visualized in this study when a gastric graft replaced an esophagus after esophagectomy. To construct visualization models for gastric grafts, the path data of gastric graft were extracted from the CT images for real patients and then the experimental models were made from silicone tube by considering elasticity of real stomach. During experiments, 200 ml of water or glycerin was poured into the gastric graft model and the gastric emptying time for total volume of fluid to pass pylorus was measured from the successive images captured by a high speed CCD. The gastric emptying time was compared according to the change of diameter and path (front or rear path) of gastric graft, and pyloroplasty or not. In case that the pyloroplasty was not conducted, the smaller was the diameter of gastric graft, the shorter was the gastric emptying time. However, if the pyloroplasty was conducted, the larger diameter of gastric graft was better for the gastric emptying. Although the rear path gave rise to longer gastric emptying time than the front path, it did not matter, if the pyloroplasty was conducted.