• Journal of Chest Surgery
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• v.27 no.8
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• pp.717-721
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• 1994

Extramucosal esophagomyotomy by thoracotomy, first described by Heller in 1913 was the principal therapy for achalasia. Recently however, video-assisted thoracoscopic surgery has been implied in esophageal surgery, and we have experienced 23 year old male patient with dysphagia and was diagnosed as achalasia who underwent thoracoscopic esophagomyotomy. The esophagogram showed typical bird beak appearance and the lower esophageal sphincter pressure was increased to 35 mmHg. Thoracoscopic surgery was done twice due to incomplete myotomy in first operation and the patient was released of dysphagia in the second operation.

• Journal of Chest Surgery
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• v.17 no.4
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• pp.792-795
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• 1984

The modified Hellers myotomy for esophageal achalasia is known as the best procedure. A properly performed transthoracic esophagomyotomy is essential to prevent complications. But it has some problems such as persistent achalasia due to inadequate myotomy, recurrence due to the healing of myotomy and reflux esophagitis due to destruction of the lower esophageal sphincter. The methods of the reoperation after esophagomyotomy for achalasia of the esophagus consist of 1 ] for persistent achalasia due to inadequate myotomy, additional myotomy feasible. 2] for esophageal reflux, a long-limb jejunal gastric drainage after vagotomy and hemigastrectomy, jejunal after conservative resection for stricture. We experienced 3 cases of reoperation after esophagomyotomy for achalasia of the esophagus. The 1st and 3rd case belongs to 30 cases which were undertaken the primary operation at the National Medical Center from 1961 to 1984. The 2nd case was undertaken the primary operation at other hospital. The 1st and 3rd case were reoperated because of persistent achalasia due to inadequate myotomy and 2rid case was caused by stricture due to reflux esophagitis. The methods of the reoperation were additional myotomy in 1st case, esophagogastrectomy and lower thoracic esophagogastrostomy in 2nd case, and esophagogastrectomy and mid-thoracic esophagogastrostomy in 3rd case. All three cases were complicated with postoperative reflux esophagitis.

• Journal of Chest Surgery
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• v.26 no.10
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• pp.815-820
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• 1993

We experienced a case of esophageal leiomyoma combined with achalasia that is very rare. Patient had suffered from severe dysphagia and postprandial vomiting and diagnosis was accomplished by esophagography, esophagoscopy, chest CT, and esophageal motility test. The operative treatment was done through left lateral thoracotomy by enucleation of the submucosal tumor and esophagomyotomy. By histopathological findings, the diagnosis of leiomyoma was confirmed and LES biopsy revealed absence of the ganglion cells of myenteric and Auerbach`s plexus. Symptoms of the patient were completely relieved and postoperative course was uneventful.

• Journal of Chest Surgery
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• v.13 no.4
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• pp.470-474
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• 1980

Achalasia is a neurogenic esophageal disorder, characterized by incomplete relaxation of the gastroesophageal sphincter in response to deglutition and absence of peristalsis from the body of the esophaugs. Because there is no known method by which esophageal peristalsis can be restored, therapy is directed toward the relief of dital esophageal obstruction. During the period of June 1965 to September 1980, 13 cases of achalasia were operated at the Department of Thoracic SUrgery, Seoul Natonal University Hospital. 1. Among 13 cases, 5 were male and 8 were female. 2. Esophagomyotomy was performed in 12 cases, and 1 case was treated with transverse suture of lower esophagus after longitudinal incision. 3. There was no operative mortality, but 2 cases subsequently underwent esophagogastrostomy after esophagomyotomy. 4. One of 13 cases was combined with mongolism.

• Journal of Chest Surgery
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• v.31 no.1
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• pp.46-51
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• 1998

Treatment of esophageal perforation when diagnosed late remains controversial. Ten consecutive patients since 1990 were treated late(later than 24 hours) for esophageal perforation with primary repair. Four perforations were iatrogenic, 3 were spontaneous, 2 were foreign body aspiraton and 1 was trauma. The interval from perforation to operation was 116 hours in mean and 48 hours in median value. The principles of repair included (1) a local esophagomyotomy proximal and distal to the tear to expose the mucosal defect and intact mucosa beyond, (2) debridement of the mucosal defect and closure, (3) reapproximation of the muscle, and (4) adequate drainage. The repair was buttressed with parietal pleura or pericardial fat in 9 patients. Associated distal obstruction was treated with dilation and esophagomyotomy intraoperatively. There was one mortality and cause of death was massive gastric bleeding due to gastric ulcer on 33rd day after operation. Five patients had leak at the site of repair and these cases were treated completely with conservative treatment except a mortality case. In conclusion, in the absence of malignant or irreversible distal obstruction, meticulous repair of perforated esophagus and adequate drainage are preferred approach, regardless of the duration from the injury to the operation.

• Journal of Chest Surgery
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• v.34 no.11
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• pp.883-886
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• 2001

Mediastinal fibrosis is uncommon but may result in entrapment and erosion of vital mediastinal structures by fibrous tissues. Idiopathic mediastinal fibrosis involved esophagus is very rare, and only a few cases have ever been reported. Such idiopathic mediastinal fibrosis involved esophagus is an enigmatic inflammatory fibrous tissue proliferation, but the treatment has not yet been clearly defined. We had successfully treated in such a case with partial esophagolysis and esophagomyotomy.

• Journal of Chest Surgery
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• v.31 no.4
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• pp.432-435
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• 1998

Idiopathic cricopharyngeal achalasia is a rare condition that produces oropharyngeal dysphagia. It is caused by spasm of the cricopharyngeus and inability to relax with swallowing. A prominent muscle bar at the upper esophageal sphincter is a typical finding of the esophagogram. Cricopharyngeal myotomy is the treatment of choice. We report a case of cricopharyngeal myotomy for 61-year-old female patient.

• Journal of Chest Surgery
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• v.31 no.4
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• pp.427-431
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• 1998

Diffuse esophageal spasm(DES) is a rare disease seen in 4% of all patients studied in an esophageal motility laboratory, and its diagnosis and surgical management is still controversial. Recently, we treated two patients by extended esophageal myotomy for diffuse esophageal spasm which was diagnosed by the clinical symptoms of patients, esophagoscopy, esophagography, and esophageal manometry. The successful result of treatments was proved with subsidence of previous clinical symptoms(dysphagia and chest pain), postoperative esophagography and esophageal manometry. We present the results together with the review of literatures.

• Journal of Chest Surgery
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• v.40 no.9
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• pp.655-658
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• 2007

Esophageal perforation is relatively uncommon but it often cause fatal if not properly treated, and it is associated with high morbidity and mortality. We report here on two cases of esophageal perforation caused by Boerhaave syndrome or pneumatic dilatation for treating achalasia. The patients were successfully treated with thoracoscopic primary repair and esophagomyotomy.

• Clinical and Experimental Pediatrics
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• v.63 no.11
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• pp.447-450
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• 2020

Background: Esophageal stricture (ES) is an uncommon clinic entity in pediatrics that may be congenital or acquired in childhood. Acquired noncaustic ES is very rare, and clinical features of affected patients are unknown. Purpose: We aimed to evaluate the clinical findings, and outcomes of patients with acquired noncaustic ES to aid physicians in the early referral of patients to gastroenterologists. Methods: The medical data of patients with acquired noncaustic ES who were followed in our gastroenterology clinic between January 2009 and December 2019 were reviewed. Results: Acquired noncaustic ES was found in 12 of the 4,950 patients (0.24%) who underwent endoscopy during the study period. The main symptoms were dysphagia (58.3%), vomiting (33.3%), and chronic anemia (8.3%). Chronic malnutrition and underweight were found in 66.6% of the patients. The most common etiological factors were radiotherapy, peptic reflux, and achalasia (16.6%, each), while chemotherapy, squamous-cell carcinoma (SC) of the esophagus, eosinophilic esophagitis (EoE), esophageal web, epidermolysis bullosa, and esophageal diverticulum (8.2%, each) were the other etiological factors. Patients with EoE underwent endoscopic bougie dilation in addition to steroid use and elimination diet. Patients with epidermolysis bullosa and esophageal web underwent bougie dilation. Patients with peptic reflux-related ES were initially put on antireflux therapy, but during follow-up, one patient required esophageal replacement with colonic interposition. Patients with radiotherapy-related ES recovered with medical therapy. The patient with initially underwent surgical gastrostomy and tumoral mass excision. The patient then received chemotherapy and radiotherapy and underwent jejunal interposition. Patients with achalasia underwent surgical esophagomyotomy. Conclusion: The presence of solid dysphagia, malnutrition, and an associated disease may alert physicians to the presence of ES.