• Journal of Gastric Cancer
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• v.3 no.2
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• pp.93-96
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• 2003

Purpose: Synthetic absorbable monofilaments offer excellent glide characteristics and cause minimal tissue trauma as a result of their smooth monofilament structure and gradual absorption within the healing tissues. For these reasons, these suture materials are commonly used in various surgical fields such as gastroenterology, urology, gynecology, and plastic surgery. The aim of this study was to evaluate the safety and usefulness of a new synthetic absorbable monofilament, Glycoside-..-caprolactone-trimethylene carbonate interpolymer (GCT), in gastrointestinal anastomosis and closure. Materials and Methods: We evaluated 55 gastrointestinal anastomoses and closures using GCT $MONOSYN^{R}$, B. Braun, Germany) in 47 patients who underwent gastric surgery between December 2001 and May 2002 at Seoul National University Hospital. Patient's characteristics, operative procedure, surgeon's opinion of handling properties of GCT, and suture-related complications were analyzed. Results: There were 34 males and 13 females (M:F= 2.6:1) with an average age of 54.2 years old. Forty-five cases of gastrointestinal anastomosis (20 gastrojejunostomies and 25 jejunojejunostomies) and 10 cases of intestinal closure (7 gastrostomy closures and 3 duodenal stump closures) were performed in 41 cases of stomach cancer, three of peptic ulcer disease, two of GIST, and one MALToma. The handling properties of GCT according to the criteria of knot breaking load, knot security, and placing property were always scored with 7 to 9 points (10=excellent, 1=very poor). Two cases of postoperative complications ($3.6\%$) were noted. One was a leak of the gastrojejunostomy site which was successfully managed conservatively, and the other was a stricture of the gastrojejunostomy site which was managed by reoperation (side-to-side jejunojejunostomy). Conclusion: GCT seems to be an applicable suture material for various gastrointestinal anastomoses and closures.

• Clinical Endoscopy
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• v.56 no.2
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• pp.239-244
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• 2023

Tuberculosis is an adverse event in patients with Crohn's disease receiving anti-tumor necrosis factor (TNF) therapy. However, tuberculosis presenting as a bronchoesophageal fistula (BEF) is rare. We report a case of tuberculosis and BEF in a patient with Crohn's disease who received anti-TNF therapy. A 33-year-old Korean woman developed fever and cough 2 months after initiation of anti-TNF therapy. And the symptoms persisted for 1 months, so she visited the emergency room. Chest computed tomography was performed upon visiting the emergency room, which showed BEF with aspiration pneumonia. Esophagogastroduodenoscopy with biopsy and endobronchial ultrasound with transbronchial needle aspiration confirmed that the cause of BEF was tuberculosis. Anti-tuberculosis medications were administered, and esophageal stent insertion through endoscopy was performed to manage the BEF. However, the patient's condition did not improve; therefore, fistulectomy with primary closure was performed. After fistulectomy, the anastomosis site healing was delayed due to severe inflammation, a second esophageal stent and gastrostomy tube were inserted. Nine months after the diagnosis, the fistula disappeared without recurrence, and the esophageal stent and gastrostomy tube were removed.

• Journal of Chest Surgery
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• v.38 no.2 s.247
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• pp.123-131
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• 2005

Background: The number of elderly patients undergoing coronary artery bypass grafting (CABG) is increasing. Elderly patients are at increased risk for a variety of perioperative complications and mortality. We identified determinants of operative complications and mortality in elderly patients undergoing CABG. Material and Method: Between January 1995 and July 2003, 91 patients older than 75 years underwent isolated CABG at Asan Medical Center. There were 67 men and 24 women with mean age of $77.0\pm2.4$ years. Thirty clinical or hemodynamic variables hypothesized as predictors of operative mortality were evaluated. Result: CABG was performed under emergency conditions in 5 patients. The internal thoracic artery was used in 85 patients and 10 patients received both internal thoracic arteries. The mean number of distal anastomosis was 3.7 per patient. Operative mortality was $3.3\%$. Twenty-two patients had at least one major postoperative complication. Low cardiac output syndrome was the most common complication, followed by reoperation for bleeding, pulmonary dysfunction, perioperative myocardial infarction, stroke, acute renal failure, ventricular arrhythmia, upper gastrointestinal bleeding, infection, and delayed sternal closure. None were the predictors of mortality. Renal failure, peripheral vascular disease, emergency operation, recent myocardial infarction, congestive heart failure, New York Heart Association (HYHA) class III or IV, Canadian Cardiovascular Society (CCS) angina scale III or IV, and low left ventricle ejection fraction below $40\%$ were univariate predictors of overall complications. Actuarial probability of survival was $94.9\%,\;89.8\%,\;and\;83.5\%$ at postoperative 1, 3 and 5 years respectively. During the follow-up period $93.3\%$ of patients were in NYHA class I, or II and $91.1\%$ were free from angina. Conclusion: Although operative complication is increased, CABG can be performed with an acceptable operative mortality and excellent late results in patients older than 75 years.