• Advances in pediatric surgery
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• v.10 no.2
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• pp.92-98
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• 2004

The history of esophageal replacement in infants or children is the history of development of various kinds of alternative conduits such as stomach, colon, and small bowel. The gastric tube has been the most widely used conduit. From January 1988 to May 2003, 23 esophageal replacements with gastric tube were performed at the Department of Pediatric Surgery, Seoul National University Childrens Hospital. Statistical analysis was performed using Windows SPSS11.0 Pearson exact test. There were Gross type A(n=10), type B(n=1), type C(n=11), type D(n=1). Ten patients who had long gap esophageal atresia (type A-8, type B-1, type C-1) and 13 patients (type A 2, type C-10, type D-1) who had stenosis, leakage, recurred tracheoesophageal fistula, and esophagocutaneous fistula after previous corrective operations, had esophageal replacement with gastric tube. Mean follow-up periods were 4 year 2 months (7 months-15 year 1 month). There were postoperative complications including GERD in 16 (69.6 %), leakages in 7 (30.4 %), diverticulum at anastomosis in 2 (8.7 %), anastomosis site stenosis in 4 (17.3 %), and distal stenosis of the gastric tube in 1 (4.3 %). There was no statistical significance between operation types and postoperative leakage and gastroesophageal reflux. In conclusion, esophageal replacement with gastric tube may be a useful surgical option in esophageal atresia with long gap and esophageal atresia complicated by previous corrective operation.

• Korean Journal of Veterinary Research
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• v.60 no.2
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• pp.49-54
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• 2020

The goal of this study was to determine if there was a difference in leak pressure between esophageal-esophageal anastomosis and esophageal-jejunal anastomosis when using cadaveric porcine tissue. Leak pressures were recorded for esophageal-esophageal anastomosis (Group 1 [control group], n = 7), cranial esophageal-jejunal anastomosis (Group 2, n = 7), and jejunal-caudal esophageal anastomosis (Group 3, n = 6). Each anastomosis was performed using polydioxanone sutures in a simple interrupted pattern. Results were analyzed using one-way analysis of variance. Mean ± SD of the leak pressures for groups 1, 2, and 3 were 46.1 ± 15.9, 36.5 ± 13.6, and 50.9 ± 11.1 mmHg, respectively (p = 0.18). When the results from groups 2 and 3 were combined and compared to that for Group 1, the mean ± SD leak pressures were 46.1± 15.9 and 43.1± 14.2 mmHg, respectively (p = 0.67). These results provide preliminary evidence that the jejunum may be a suitable option for use in esophageal replacement surgery; however, future studies of in vivo factors influencing the integrity of esophageal-jejunal anastomoses, including histologic evaluation of esophageal-jejunal anastomosis healing, are needed.

• Advances in pediatric surgery
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• v.3 no.2
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• pp.152-159
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• 1997

Transhiatal gastric transposition was performed in two case of long gap esophageal atresia without tracheoesophageal fistula. The patients were a 12 months old female and an 18 months old male. Stamm type gastrostomies were performed at other hospitals in both cases. The stomach was mobilized preserving the right gastric artery, the right gastroepiploic artery and spleen. A portion of the proximal and the distal esophageal segment were excised by transcervical and transhiatal route, respectively. The mobilized stomach was pulled up to the neck through the esophageal hiatus and posterior mediastinum. The esophagogastrostomy, the only one anastomosis of this procedure, was performed in the neck. There was no clinical evidence of anastomotic leakage, stricture, regurgitation, difficulty of gastric emptying, hoarseness or respiratory problem. Transhiatal gastric transposition seems to be a safe and easy alternative surgical procedure for esophageal replacement in long gap esophageal atresia.

• Journal of Chest Surgery
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• v.49 no.1
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• pp.54-58
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• 2016

A 49-year-old male presented with chills and a fever. Five years previously, he underwent ascending aorta and aortic arch replacement using the elephant trunk technique for DeBakey type 1 aortic dissection. The preoperative evaluation found an esophago-paraprosthetic fistula between the prosthetic graft and the esophagus. Multiple-stage surgery was performed with appropriate antibiotic and antifungal management. First, we performed esophageal exclusion and drainage of the perigraft abscess. Second, we removed the previous graft, debrided the abscess, and performed an in situ re-replacement of the ascending aorta, aortic arch, and proximal descending thoracic aorta, with separate replacement of the innominate artery, left common carotid artery, and extra-anatomical bypass of the left subclavian artery. Finally, staged esophageal reconstruction was performed via transthoracic anastomosis. The patient's postoperative course was unremarkable and the patient has done well without dietary problems or recurrent infections over one and a half years of follow-up.

• Korean Journal of Bronchoesophagology
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• v.9 no.2
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• pp.69-73
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• 2003

Various flaps are using for reconstruction of esophageal defect. The choice of reconstruction is depended to the oncologic needs of the situation. If the entire esophagus or significant part of the thoracic esophagus is involved by tumor, then total esophagectomy and gastric pull-up or colon transposition is indicated. But for most hypopharyngeal tumors, laryngopharyngeal tumors, and cervical esophageal tumors, segmental resection of these area and replacement with a jejunal fee or forearm free flap has become the standard technique. The authors have experienced a case of total pharyngo-laryngo-esophago-gastrectomy and colon transposition in a patient of esophageal cancer following partial esophagectomy and gastic pull-up due to corrosive esophageal stricture. We report this case with brief review of the literatures.

• Journal of Chest Surgery
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• v.55 no.1
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• pp.81-84
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• 2022

Esophagectomy and esophageal reconstruction are commonly chosen as surgical options for esophageal cancer. However, prolonged untreated chyle leakage is associated with a poor prognosis. We report the case of a patient with refractory chylous ascites. To limit the ongoing fluid loss, we utilized the chylous ascites as an additional fluid source in a renal replacement therapy system. A continuous renal replacement therapy (CRRT) drainage system was modified to drain both the chylous ascites and venous blood. The ascites drainage rate was determined empirically and regulated by a dial-flow extension set. The CRRT mode was set to continuous venovenous hemodiafiltration and maintained for 7 days. After the patient was weaned from CRRT, ascites did not reaccumulate, and the patient's general condition improved dramatically. No infections related to the system occurred. This procedure temporarily alleviates symptoms and provides more time for alternative treatment strategies.

• Advances in pediatric surgery
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• v.1 no.2
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• pp.162-169
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• 1995

Since 1988, we have performed esophageal replacement with the reversed gastric tube on four esophageal atresia patients. Three patients had long-gap esophageal atresias and one patient had recurrent tracheoesophageal fistula that was previously operated on three times. One combined imperforate anus. The youngest patient was 6-month-old and the oldest, 34-month-old at the time of procedure. The technique of gastric tube construction is described. There have been both major and minor complications. Although two patients had shown distal tube strictures as late complications. those were solved with tuboplasties on 29 months and 48 months, postoperatively. Growth and development have been acceptable in all four patients, although most remain in the lower percentiles for growth and height, a condition that usually predates the esophageal substitution. Conclusively, reversed gastric tube interposition has proved very satisfactory for long-gap esophageal atresia that cannot be anastomosed primarily even by spiral myotomy and esophageal atresia with recurrent tracheoesophageal fistula having destroyed esophagus due to previous operation.

• Journal of Digestive Cancer Research
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• v.11 no.2
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• pp.61-65
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• 2023

Globally, esophageal cancer is the seventh most common cancer, and the male-to-female ratio in esophageal adenocarcinoma (EAC) is significantly imbalanced at 4:1 to 8:1. Obesity, reflux, and smoking are known risk factors for this sex difference; however, fully explaining this remains challenging. Studies have investigated the link between exogenous sex hormones and esophageal cancer occurrence. A meta-analysis revealed a lower risk of EAC in female who had undergone hormone replacement therapy. Androgen-deprivation therapy in patients with prostate cancer was associated with a decreased risk of EAC. Tissue-based studies have reported varied results regarding the relationship between estrogen receptor expression and survival in female patients with esophageal squamous cell carcinoma (ESCC). Circulating hormone studies have suggested that higher testosterone and luteinizing hormone levels decreased EAC risk in men, and free testosterone was inversely correlated in female with ESCC. However, a high androgen-estrogen ratio in male patients with EAC was linked to increased odds of EAC. Sex hormones influence carcinogenesis, affecting cell proliferation, differentiation, metabolism, inflammation, and cell death. The studies were limited by the small sample size and varying hormone measurement methods; thus, future studies with definitive conclusions on the association between esophageal cancer and sex hormones are warranted.

• Journal of Chest Surgery
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• v.35 no.4
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• pp.322-324
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• 2002

Herein we report a rare case of primary esophageal malignant melanoma in a 56-year-old gentleman who presented with a 2-month dysphagea. Esophagoscopy reveals a polypoid tumor and a total thoracic esophagectomy was performed through a right thoracotomy and esophageal replacement with stomach. The tumor was proven to be a primary esophageal malignant melanoma by histological and immunohistochemical studies. The pathologic stage was IIa. He received no postoperative adjuvant therapy. He died of liver metastasis at 8 months postoperatively.

• Advances in pediatric surgery
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• v.3 no.1
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• pp.47-53
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• 1997

Accidental ingestion of caustic substance is one of the common problems among children around the world. Acid intake accounts for a mere 5% of all reported cases of corrosive ingestion in the West. Because of the esophageal sparing effect of acid, clinically significant esophageal involvement after acid ingestion occurs in only 6 to 20 percent of the instances. Despite effort of prevention, 7% to 15% of children sustaining caustic esophageal burns develop esophageal strictures. If balloon dilatation or bougie dilatation fails to resolve the esophageal strictures, successful outcome following replacement by colon or stomach has been reported in children. But the complications and morbidity following these operations are still relatively high. Seven patients with corrosive-acid induced esophageal strictures who were operated upon at the Department of Pediatric Surgery, Seoul National University Children's Hospital from 1991 to 1995 were reviewed. Primary resection and anastomosis was performed in all of 7 patients. The stricture involved short segments of the esophagus at the level of the lower cervical and the upper thoracic vertebra. The operations were approached through a left cervical incision or a left thoracotomy. In one patient, operative repair of anastomotic leakage was done, and three patients required re-resection of anastomotic strictures postoperatively, and one patient required a third operation(reversed gastric tube) due to an anastomotic stricture. The other anastomotic leaks, strictures or pulmonary complications were resolved with conservative treatment. In conclusion, primary resection and anastomosis of the esophagus was performed successfully on the 6 of 7 children with acid induced corrosive esophageal strictures. This approach is physiologic, especially in children who should have a long life expectancy, and recommended for the treatment of short-segment acid induced corrosive esophageal strictures.