• Journal of Chest Surgery
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• v.29 no.4
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• pp.420-426
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• 1996

We previously reported 344 cases of esophageal reconstruction for caustic esophageal stricture between 1959 and 1982, and this is the second report of 69 cases during 12 year period from Jan. 1983 to Feb. 1995. There were 32 males and 37 females, ranging in age from 4 to 65 years(mean 36.4 years). Caustic materials were acid in 37 (53.7%) and alkali in 31 (44.9%). All cases underwent colon interposition without esophageal resection except 3 cases of cancer complication which were resected through thoracotomy. In 64 cases isoperistaltic right colon with teminal ileum interposition were performed, and 5 cases were interposed with left colon either isoperistaltic (2 cases) or antiperistaltic (3 cases) method. Anastomotic leakage was the most frequently encountered c mplication (14.4%, 10 cases), and they were 11.6%(8 cases) from cervical, 2.8% (2 cases) from ileocolostoma. Overall operative mortality was 2.9% (2169), main causes of death were sepsis due to graft necrosis and mediastinitis. During 6 months to 12years (mean 2.Syears) follow-up of survived 67 cases, 88.1% (59 cases) ate normally, 7.5% (5 cases) complained of moderate dysphagia (eating liquid diet), and 4.5% (3 cases) were unable to eat by mouth. In our experience, reconstruction of the esphagus with the colon is a satisfactory method that can be accomplished with acceptable morbidity and mortality. The right colon is a durable and functional esophageal substitute.

• 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.28 no.2
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• pp.170-176
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• 1995

Fourty nine patients out of 127 esophageal cancer were managed surgically from January 1986 to December 1991, at the Department of Thoracic and Cardiovascular Surgery, Jeonbuk National University Hospital. Most frequent preoperative symptom was dysphagia and its mean duration was 3.1 months. In histopathologic examination, squamous cell carcinomas were 44 cases [89.8% , and adenocarcinomas 5 [10.2% . The tumor location were the upper esophagus in 6.1%, middle esophagus in 57.2%, lower and cardiac portion of stomach in 36.7%. Involved and metastatic organs, which were detected perioperatively, were celiac lymph nodes in 6 cases, aorta 2, stomach 2, pericardium 2, cervical lymph node 1. The esophagus was resected radically, and the procedures for esophageal replacement were performed with esophagogastrostomy in 45 cases, esophagocologastrostomy 3, and esophagojejunostomy 1. Postoperative complications occurred in 16 cases [hospital morbidity = 32.6% ,anastomotic leak 3, anastomotic stricture 2, respiratory insufficiency 2, hemoperitoneum 1, chylothorax 1, intussusception 1, empyema 1, non-A,non-B hepatitis 1, and mediastinitis 1. Hospital deaths were experienced 3 cases [ hospital mortality = 6.1% . The 6 month, one, two, and five year actuarial survival rates were 85.7%, 71.4%, 57.1%, and 27.9%, respectively. One year survival rates of stages were 100% in stage I, 90.9% in stage IIa, 63.6% in stage IIb, 25.0% in stage III, and 7.2% in stage IV.

• Korean Journal of Bronchoesophagology
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• v.5 no.1
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• pp.14-21
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• 1999

Perforating injury of the thoracic esophagus leads to an almost Immediate exposure of the mediastinum to both oral secretions and refluxed gastric contents. And necrotizing inflammatory response developed inevitably. So, without proper managements, mediastinitis results in severe dehydration or septic conditions, and consequently the life of the patient can be threaten. We experienced recently 4 cases of esophageal perforation. Three cases were Boerhaave's syndromes and the other one was instrumental perforation in patient with corrosive esophageal stricture. Curative surgical procedures were done in 3 cases and the drainage procedure was only possible in the other one due to hepatic failure. And the patient with the drainage management was dead.

• Journal of Chest Surgery
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• v.35 no.6
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• pp.479-482
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• 2002

Aortoesophageal fistula induced by endoesophageal stent is rare; however, it is usually a fatal disorder, with few survivors reported. We report a case of a 32-year old female with aortoesophageal fistula after insertion of the esophageal stent in esophageal lye stricture who was successfully diagnosed with endoscopy and treated in a two-stage operation. In the first stage, we performed esophagectomy, primary repair of the fistula site in the descending thoracic aorta, and feeding gastrostomy. After the patient recovered well postoperatively, a retrosternal interposition of the right colon and cervical esophago-colo-grastostomy were performed, to re-establish the gastrointestinal tract.

• Journal of Chest Surgery
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• v.30 no.4
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• pp.457-461
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• 1997

L casts of Barrett's esophagus complicated with stricture is reported. A 82 years old male was undergone distal esophagectomy '||'&'||' esophagogastrostomy on suspicion of malignancy. The microscopic examination of specimen taken from the lesion revealed the "tall columnar cells" which were indicative of Barrett's esophagus, hence the diagnosis. Barrett's esophagus is a rare disease in Korea. Because of the malignant potential of the disease, surgery involving esophagectomy is often required.d.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.3 no.1
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• pp.1-8
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• 2000

Purpose: This study was undertaken to evaluate the clinical features and complication such as esophageal stricture in children with corrosive esophagitis. Methods: We retrospectively reviewed medical records of 31 children who accidentally ingested corrosive materials and visited to emergency room of Chonnam National University Hospital from Jan. 1992 to Dec. 1999. Twenty-one children were examined by upper gastrointestinal (UGI) endoscopy to evaluate location and severity of caustic injury. Results: 1) Among 31 patients, there were 20 males and 11 females and the ratio of male to female was 2:1. Average age at diagnosis was 2.3 years (12 months to 9.8 years). Twenty-seven (87.1%) patients were accidentally ingested vinegar. 2) Initial presenting symptoms were dysphagia (54.8%), vomiting (48.3%), chemical burn on lips and skin (45.2%), excessive salivation (45.2%), coughing and respiratory grunting (32.3%) and aspiration pneumonia (9.8%). 3) UGI endoscopic examination showed caustic injury in 17 children: grade I in 8, grade II in 7 and grade III in 2. The region of caustic injury was proximal esophagus in 5, distal esophagus in 3, entire esophagus in 9 and stomach in 6. 4) Corrosive esophageal strictures developed in 6 children (19.4%) and gastric outlet stricture in 1 (3.2%). All of them showed grade II or III caustic injury on endoscopic examination. Conclusion: The development of esophageal stricture was related to the severity of the caustic injury. Early UGI endoscopic examination in caustic ingestion seems to be useful for prediction of development of caustic stricture.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.99-105
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• 1996

The reconstruction of esophageal defect after ablative surgery have more difficult than other digestive tract tumor because the restoration of anatomical and physiologic function is difficult, the risk of tumor invasion into the adjacent tissue is large. The reconstruction of cervical esophus was depended on the degree of resection of the esophagus, various reconstruction method was developed to minimize functional deficiency and deformity of cervical region. Recently, the free jejunal transfer or free radial forearm flap was commonly utilized for esophageal reconstruction due to development of technique of the microvascular anastomosis. After the esophageal reconstruction used by free jejunal transfer was reported by Seidenberg in 1951, jejunum is most commonly used for reconstruction of esophgus. Becaue of, it have been tubed anatomical similarity with muscular layer, relative small risk of complication, possible of oral intake within 10 days after operation, and early rehabilitaion. Authors have been treated esophageal defect with free jejunal transfer in 7 patients after resection of lesion in 6 eshageal cancer and 1 esophageal stricture from December 1994 to January 1996. We were transferred jejunum used by intercostal artery as recipient artery in 3 cases, it was satisfied with results. If intercostal artery was utilized as recipient artery for free jejunal transfer, we believe that any site of intrathoracic or intraabdominal esophageal defect is possible to recontruction.

• Journal of Chest Surgery
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• v.21 no.3
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• pp.526-530
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• 1988

Acquired communicated fistula between the esophagus and respiratory system are infrequent and they are caused by carcinoma, trauma, infection and traction. This report reviews the feature of acquired esophagobronchial fistula[that developed spontaneously]. Patient is 34 year old man with excellent result by surgical intervention. The surgical procedures consist of division and repair of the fistula. Clinically and radiologically, the patient is free from coughing after drinking, substernal distress, esophagorespiratory fistula, and esophageal stricture after surgical treatment.

• Journal of Chest Surgery
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• v.24 no.11
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• pp.1107-1114
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• 1991

We have experienced fourteen patients of esophageal perforation at the department of thoracic and cardiovascular surgery, Chonbuk National University Hospital during the period from mar. 1980 to Oct. 1990. The ratio between male and female patients was 5 : 9, and their age ranged from 22 years to 69 years. The causes of th eesophageal perforation were iatrogenic in 6 cases, foreign body 5 cases, diverticulitis 2 cases, and postpneumonectomy 1 case. The locations were cervical esophagus in 2 cases, upper thoracic in 2 cases, mid-thoracic 4 cases, and lower thoracic 6 cases. The underlying diseases associated with perforation were lye stricture, diverticulum, achalasia, and postpneumonectomy empyema. The treatments were supportive in 6 cases and combined with surgical measures in 8 cases. surgical measurs were as follows : incision and drainage in 2 cases, esophagectomy with esophagogastrostomy 3 cases, esophagocardiomyotomy with partial fundoplication in 1 case, simple closure with myoplasty and thoracoplasty 1 case, and empyema drainage and gastrostomy 1 case. There was no mortality.