• Journal of Gastric Cancer
• /
• 제16권3호
• /
• pp.200-206
• /
• 2016

In Korea, proximal gastrectomy has recently attracted attention as a better choice of function-preserving surgery for proximal early gastric cancer than total gastrectomy. Of the various strategies to overcome reflux symptoms from remnant stomach, double tract reconstruction not only reduces the incidence of anastomosis-related complications, but is also sufficiently reproducible as a laparoscopic procedure. Catching up with the recent rise of single-port laparoscopic surgeries, we performed a pure single-port laparoscopic proximal gastrectomy with DTR. This procedure was designed by merging the function-preserving concept of proximal gastrectomy with single-port laparoscopic total gastrectomy.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• 제6권2호
• /
• pp.183-186
• /
• 2003

저자들은 반복적인 구토와 복통이 발생한 후 토혈을 주소로 내원한 3세 된 남아에서 상부소화관 내시경으로 진단된 위식도 탈출증 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• 대한한방내과학회지
• /
• 제31권1호
• /
• pp.128-141
• /
• 2010

Purpose : The object of this study was to observe the suppressive effects of Yijintang-gamibang (YJGMB), Yijintang with Atractylodis Rhizoma, Massa Medicata Fermentata, Hordei Fructus Germiniatus, and Coptidis Rhizoma. YJGMB has been traditionally used in Korean medicine for treating various digestive diseases. We tested it on the rat reflux esophagitis (RE) induced by pylorus and forestomach ligation in rats as compared with omeprazole, a well-known proton pump inhibitor. Method : Three different dosages of YJGMB 200, 100 and 50mg/kg, were orally pretreated once a day for 28 days before pylorus and forestomach ligation. Seven groups, each of 8 rats per group were used in the study. Six hours after pylorus and forestomach ligation, changes of the stomach and esophagus lesion areas, gastric volumes, acid and pepsin outputs, invasive lesion percentages, fundic mucosa and total thicknesses were measured as histomorphometry. The results were compared with omeprazole, antioxidant and proton pump inhibitor, and 30 and 10mg/kg treated groups in which the effects on RE were already confirmed. Results : As results of pylorus and forestomach ligation, marked increases of esophageal and gastric mucosa lesion areas, gastric volumes, acid outputs, pepsin outputs were observed with histopathological changes of RE, such as hemorrhages, ulcerative lesions and edematous changes on the fundic mucosa. However, these pylorus and forestomach ligation-induced RE were dose-dependently inhibited by treatment of 200, 100 and 50mg/kg of YJGMB. YJGMB 200mg/kg showed similar protective effects as compared with 30mg/kg of omeprazole in the present study, and more favorable effects were observed in 50mg/kg of YJGMB treated rats as compared with omeprazole 10mg/kg in the present study. Conclusion : The results obtained in this study suggest that YJGMB has favorable protective effects on the RE induced by pylorus and forestomach ligation. Therefore, it is expected that YJGMB will also show favorable effects on RE corresponding well to the suggestion of traditional Korean medicine. However, more detailed mechanism studies should be conducted in future with the screening of the biological active chemical compounds in herbs.

• Advances in pediatric surgery
• /
• 제10권2호
• /
• pp.92-98
• /
• 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.

• Journal of Gastric Cancer
• /
• 제16권2호
• /
• pp.63-71
• /
• 2016

Pylorus-preserving gastrectomy (PPG) is a function-preserving surgery for the treatment of early gastric cancer (EGC), aiming to decrease the complication rate and improve postoperative quality of life. According to the Japanese gastric cancer treatment guidelines, PPG can be performed for cT1N0M0 gastric cancer located in the middle-third of the stomach, at least 4.0 cm away from the pylorus. Although the length of the antral cuff gradually increased, from 1.5 cm during the initial use of the procedure to 3.0 cm currently, its optimal length still remains unclear. Standard procedures for the preservation of pyloric function, infra-pyloric vessels, and hepatic branch of the vagus nerve, make PPG technically more difficult and raise concerns about incomplete lymph node dissection. The short- and long-term oncological and survival outcomes of PPG were comparable to those for distal gastrectomy, but with several advantages such as a lower incidence of dumping syndrome, bile reflux, and gallstone formation, and improved nutritional status. Gastric stasis, a typical complication of PPG, can be effectively treated by balloon dilatation and stent insertion. Robot-assisted pylorus-preserving gastrectomy is feasible for EGC in the middle-third of the stomach in terms of the short-term clinical outcome. However, any benefits over laparoscopy-assisted PPG (LAPPG) from the patient's perspective have not yet been proven. An ongoing Korean multicenter randomized controlled trial (KLASS-04), which compares LAPPG and laparoscopy-assisted distal gastrectomy for EGC in the middle-third of the stomach, may provide more clear evidence about the advantages and oncologic safety of PPG.

• Journal of Gastric Cancer
• /
• 제4권4호
• /
• pp.225-229
• /
• 2004

목적: 위암 환자의 위절제술 후 발생하는 가슴 쓰림, 역류, 비심인성흉통 등 식도증상의 원인규명을 위해 위절제술 후 식도 산도 변화와 운동장애를 알 수 있는 24시간 보행성 식도 산도 검사(일부 환자에서 식도 내압 검사를 병행)를 실시하였다. 대상 및 방법: 2002년 7월부터 2004년 3월까지 위암으로 Billroth I을 시행한 환자와 위전절제술을 시행한 환자 중 무작위로 선택한 15예를 대상으로 술 후 음식 섭취 후 퇴원 전에 24시간 보행성 식도 산도 검사를 시행하였다. 산 역류의 양성 판정은 DeMeester 점수를 사용하여 점수 14.72 이상을 양성으로 하였고, 증상지수는 증상을 보인횟수 중 실제로 산도(pH)가 4 이하였던 경우를 나타내는 것으로 양성판정은 증상지수 $50\%$ 이상인 경우로 하였다. 결과: 무작위로 선택되어 검사한 15예 중 산역류양성 (DeMeester 14.72 이상)을 보인 예는 총 3예($20\%$)로 분석 되었다. 그 중 술 식에 따른 분포는 Billroth I경우는 총 12예 중 3예($25\%$)에서 양성반응을 보였고 위전절제술을 시행한 환자는 3예 중 양성반응을 보인 예가 없었다. 병기에 따른 분포는 각각 I (2예/9예), II (1예/2예), III (0예/3예), IV(0예/1예)였다. 10예에서 식도 내압 검사를 병행하였는데 그 중 7예에서 비특이적 식도운동장애로 분석되었다. 결론: 위암 환자의 위절제술 후 산 역류로 인한 위식도 역류질환이 발생했다. 위암수술로 Billroth I 재건술 후 생기는 위식도역류 증상은 담즙역류뿐만 아니라 위산 역류에 의해서도 생긴다.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• 제16권4호
• /
• pp.240-247
• /
• 2013

Purpose: Regurgitation is known to peak at the age of 3-4 months, with a sharp decrease around the age of 6 months. Little is known about the natural evolution of infants who still regurgitate after the age of 6 months. Methods: Hundred thirty-one infants older than 6 months regurgitating more than once a day were followed for a period of 3 months. Results: According to our data, gastroesophageal reflux disease (GERD) is seldom at this age. Most of the infants regurgitated 3 or more times/day and spit up an estimated volume of more than 15 mL. Eighty-five parents were educated regarding frequency of feeding. There were only 6 infants that still had frequent regurgitation (>3 times/day) despite an appropriate feeding schedule. The Infant GER Questionnaire score reached a score of 0 in 50% of the infants after one month of follow-up and in 81.9% at the third month of follow-up. There was an increase of the "weight for age z-score" trends in infants that still regurgitated at the end of follow-up and a declining z-score in infants that no longer regurgitated. An explanation may be that infants that regurgitate drink larger volumes than infants who do not regurgitate. Conservative treatment (reassurance, dietary treatment, behavioral advice) resulted in a significant better outcome than natural evolution. Conclusion: Regurgitation that persisted after the age of 6 months, strongly decreased during a 3-month follow-up with conservative treatment. GERD is rare in this age group; therefore, anti-reflux medication is only seldom needed.

• Journal of Chest Surgery
• /
• 제22권2호
• /
• pp.342-347
• /
• 1989

A 4-year-old male developed the esophageal perforation after air-gun shut injury in the thorax. The esophageal perforation was found on esophagogram at the next day after the accident. Because of delayed diagnosis, mediastinitis and pyopneumothorax were developed. The general conditions of the patient were very critical with sepsis on admission. Therefore, two staged operation was planned. At the first stage, exclusion and diversion of the esophagus was carried out to treat chemical pneumonitis due to gastric contents through the esophago-bronchial fistula by gastroesophageal reflux. Clinical conditions of the patient were improved after the first stage operation. At the second stage, the esophageal reconstruction with right colon was performed.

• 한국정밀공학회:학술대회논문집
• /
• 한국정밀공학회 2003년도 춘계학술대회 논문집
• /
• pp.1328-1331
• /
• 2003

As rates of gastric cancer. fatness. and GERD (chronic gastric esophageal reflux disease) patients have been increased in the world, suturing mechanism using endoscope has been focused. which is the medical instrument to apply stitches and suturing inside the body, since it helps the patients lessen pains and reduce operation time. This paper deals with mechanism design, which makes it possible to apply multiple suturing without the repeat of inserting and removing the endoscope. This successive suture mechanism includes gripper, linkage, rotational part, and articulation part. Also, the mechanism is operated through 4mm one-side channel attached to the endoscope by means of pulling wires.

• Journal of Chest Surgery
• /
• 제25권12호
• /
• pp.1436-1439
• /
• 1992

Esophageal hiatal hernia is common disorder in western sociey, and mainly affects mid-aged women, There are two types of hiatal gernia; common and more benign type is sliding [type I], and more severe type is paraesophageal [type II], and Skinner subdivided type II as true II, IIA, III, and paraesophageal group, As Skinner`s nomination, this case could be belong to IIA, which imply the state that natural hiatus is occupied with gastric antrum or duodenum instead of normal esophago-gastric junction, Main problem of paraesophageal hernia comes from its complication; intestinal obstruction, volvulus, strangulation, and incarceration, as well as pulmonary aspiration. So, as soon as confirm diagnosis, it should be corrected surgically to prevent above complications, and sometimes it could result in serious condition. We have experienced paraesophageal hiatal hernia in 3-day newborn infant and have repaired it successfully. We used transabdominal approach to repair and to prevent reflux Nissen`s fundoplication was performed. We would report that with reference study.