• Journal of Gastric Cancer
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• 제7권3호
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• pp.139-145
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• 2007

목적: Uncut Roux-en-Y gastrojejunostomy는 잔위로의 담즙 역류와 Roux stasis 증후군을 예방하는 데 효과적인 것으로 알려져 있다. 이에 원위부위절제술 후 전복강경하 uncut Roux-en-Y 위공장문합술(TLuRYGJ)의 임상적 유용성을 알아보고자 본 연구를 시행하게 되었다. 대상 및 방법: 본원에서 TLuRYGJ를 시행 받은 19영의 환자들과 같은 기간에 전복강경하 Billroth I 위절제술(TLB-I)을 시행 받은 11명의 환자들의 수술 후 6개월째 조사한 Visick 분류, 식습관, 위절제후증후군과 관련된 위장관 증상, 내시경 검사 소견 등을 비교, 분석하였다. 결과: 수술 후 6개월째에 조사한 위절제후증후군과 관련한 위장관 증상과 Visick 분류에서는 별다른 차이가 없었으나 TLuRYGJ 군 환자들 중 담즙 역류성 위염의 증상을 호소했던 환자는 한 명도 없었고 투약을 요하는 위 지연배출의 증상을 호소했던 환자가 한 명(5.3%)있었다. 수술 후 6개월째 위 내시경 검사 소견에서 TLuRYGJ 군에서 TLB-I군에 비해 담즙 역류성 잔위염이 더 적은 소견을 보였다. 결론: TLuRYGJ는 담즙 역류성 위염과 Roux stasis 증후군을 예방하는 데 효과적이었다.

• Advances in pediatric surgery
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• 제10권1호
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• pp.22-30
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• 2004

A total of 30 cases of the peptic ulcer in children, who underwent operations from January 1981 to December 1995 because of complications at Department of the Surgery, Chonbuk National University Medical School, is reviewed. Twenty-three were males (76.7%), 7 females (23.3%) and male was preponderant at 3.3:1. There were 25 cases (83.3%) age 10 to 15 years, 3(10.0%) between 2 and 9 years, and 2 (6.7%) below 2. The ulcer was located at duodenum in 27(90.0%), and at stomach in 3 cases (10.0%). Complications were perforation in 19 cases (63.3%), pyloric obstruction in 9 (30.0%) and bleeding in 2 (6.7%). For perforation, truncal vagotomy with pyloroplasty was done in 11 cases, truncal vagotomy with hemigastrectomy and gastrojejunostomy in 6, and simple closure in 2 cases. For obstruction, truncal vagotomy with hemigastrectomy and gastrojejunostomy was done in 5, and truncal vagotomy and pyloroplasty in 3 cases. For bleeding lesions, truncal vagotomy and pyloroplasty was performed in 2 cases. Ten postoperative complications developed in 9 patients: adhesive ileus in 5, recurrence in 2, pneumonia 2, and wound seroma 1 case. One patient developed a primary duodenal perforation and another a recurrent obstruction. Both of patients had symptoms for more than 3 years and were treated with truncal vagotomy and pyloroplasty for the primary operations. Hospital stay was 11.5 days for the patient with perforated ulcer, 11.0 days for the patient with pyloric obstruction, and 14.5 days for the child with bleeding. Average hospital period was 11.6 days. To reduce recurrences after operation, extensive procedure such as distal gastrectomy with vagotomy at the first operation should be considered in case with severe complication or with patients who have been symptomatic for long periods.

• Journal of Gastric Cancer
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• 제23권4호
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• pp.561-573
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• 2023

Purpose: This study aimed to compare the long-term functional and patient-reported outcomes between intra-corporeal delta-shaped gastroduodenostomy and gastrojejunostomy after laparoscopic distal gastrectomy for gastric cancer. Materials and Methods: We retrospectively reviewed clinicopathological data from 616 patients who had undergone laparoscopic distal gastrectomy for stage I gastric cancer between January 2015 and September 2020. Among them, 232 patients who had undergone delta-shaped anastomosis and another 232 who had undergone Billroth II anastomosis were matched using propensity scores. Confounding variables included age, sex, body mass index, physical status classification, tumor location, and T classification. Postoperative complications, nutritional outcomes, endoscopic findings, and quality of life (QoL) were compared between the 2 groups. Results: No significant differences in postoperative complications or nutritional parameters between the two groups were observed. Annual endoscopic findings revealed more residual food and less bile reflux in the delta group (P<0.001) than in the Billroth II group. Changes of QoL were significantly different regarding emotional function, insomnia, diarrhea, reflux symptoms, and dry mouth (P=0.007, P=0.002, P=0.013, P=0.001, and P=0.03, respectively). Among them, the delta group had worse insomnia, reflux symptoms, and dry mouth within three months postoperatively. Conclusions: Long-term nutritional outcomes and QoL were comparable between the delta and Billroth II groups. However, more residual food and worse short-term QoL regarding insomnia, reflux symptoms, and dry mouth were observed in the delta group. Longer fasting time before endoscopic evaluation and short-term symptom management would have been helpful for the delta group.

• Archives of Plastic Surgery
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• 제33권2호
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• pp.245-248
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• 2006

Besides gastric pull-up or colonic interposition, microvascular technique in esophageal reconstruction has been approved reliable methods. When free intestinal transfer is considered, jejunal free flap is commonly used. We treated the patient who had undergone reconstruction with a right colon interposition and suffered from inability of swallowing because of stricture and necrosis of the interposed flap. Although we have planned jejunal free transfer, we couldn't use jejunum due to adhesion by previous gastrojejunostomy and colon interposition. Salvage procedure with microvascualr free left colon flap was executed successfully. After 9 month follow-up, the patient was able to consume a normal diet.

• Journal of Gastric Cancer
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• 제16권1호
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• pp.51-53
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• 2016

Laparoscopic gastrectomy for cancer has some significant postoperative benefits over open surgery with similar oncologic outcomes. This procedure is more popular in the Far East countries where obesity is not a serious public health problem. In the Western countries, laparoscopic gastrectomy for cancer is not a common procedure, yet obesity is more common. Herein, we aimed to demonstrate the feasibility of laparoscopic gastrectomy for advanced gastric cancer in a morbidly obese patient. Additionally, we used natural orifice specimen extraction as an option to decrease wound-related complications, which are more prevalent in morbidly obese patients. In this case, we performed a fully laparoscopic subtotal gastrectomy with lymph node dissection and Roux-en-Y gastrojejunostomy with the specimen extracted through the vagina. To the best of our knowledge, this was the first report of a natural orifice surgery in a morbidly obese patient with gastric cancer.

• Journal of Gastric Cancer
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• 제9권4호
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• pp.231-237
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• 2009

목적: 진행성 위암 중 수술 소견에서 복강 내 원격전이가 존재하거나 주위 장기에 침윤이 심하여 절제가 불가능한 경우에 위 배출구 폐색을 동반하지 않더라도 예방적 위공장 우회술을 시행하는 경우가 있어, 단순 개복술 시행과 비교하여 그 의의를 알고자 하였다. 대상 및 방법: 1984년부터 2007년까지 고려대학교 의료원에서 수술을 시행 받은 진행성 위암 환자 중 위 배출구 폐색이 없고 절제 불가능한 4기 위암 환자 167예를 대상으로, 후향적 방법을 이용하여 임상병리학적 특성 및 치료성적, 그리고 예후 인자 분석을 시행하였다. 결과: 위 공장 우회술을 시행과 단순 개복술 시행을 비교한 결과, 나이, 성별, 간 전이 여부, 술 후 재원일, 재입원 횟수에서는 유의한 차이를 없었지만, 병소의 위치(P$\leq$0.014), 복막 파종(P=0.001)에서는 유의한 차이를 보였다. 예후 인자 분석에서는 위 공장 우회술을 시행한 군의 생존기간이 1~35.7개월(6.3개월), 시행하지 않은 군이 1~33.4개월(median 4.3개월)로 유의한 차이가 있었으며(P=0.031), 복막전이가 있는 경우 1~31.0개월(median 3.4개월), 없는 경우 1~33.3개월(median 5.8개월)로 유의한 차이를 보였다(P<0.001). 다변량 분석을 통한 독립적 예후 인자로는 복막 전이 여부만이 의미가 있었다(P=0.002). 결론: 절제 불가능한 4기 위암 환자에서 폐색 증상이 없는 경우, 예방적 위 공장 우회술은 생존기간의 연장에서 큰 의의를 가지지 못하는 것으로 생각한다.

• Journal of Gastric Cancer
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• 제7권3호
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• pp.146-151
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• 2007

목적: Pledget은 주로 심혈관계 수술에서 매듭을 보강하는 용도로 사용되는 PTFE 재질의 섬유조각이다. 연구자들은 복강경 수술에서 복강 내 매듭짓기의 횟수를 줄임으로써 복강 내 위장관 연속 손바느질을 기술적으로 용이하게 하기 위하여 pledget을 매듭의 대용으로 이용하였다. 대상 및 방법: 본원에서 전복강경하 uncut Roux-en-Y 위공장문합술을 시행 받은 32명의 환자들을 복강 내 문합의 방법에 따라 3군으로 나누어 각 군간의 수술 결과를 비교, 분석하였다. 복강 내 문합에서 기본적으로는 선형문합기를 사용하였지만 A군에서는 공장공장문합부와 위공장문합부의 문합기가 들어간 구멍을 pledget을 이용한 손바느질로 막았고, B군에서는 공장공장문합부의 문합기가 들어간 구멍을 기존의 손바느질로 막았으며, C군에서는 문합기가 들어간 구멍을 모두 선형문합기로 막았다. 결과: A군에서의 손바느질의 양이 B군에 비해 훨씬 더 많았음에도 불구하고 문합시간은 두 군 사이에 별다른 차이가 없었으며 C군의 문합시간보다는 A군의 문합시간이 더 길었다. 사용한 선형문합기 카트리지의 수는 세 군중 A군에서 가장 작았다. B군에서는 복강 내 손바느질 도중에 봉합사가 끊어지는 예가 2예 있었으나 A군에서는 그러한 예가 한 예에서도 발생하지 않았다. 결론: Pledget은 복강 내 위장관 연속 손바느질에서 매듭의 수를 줄여 문합시간을 단축하는 데 유용하였다.

• Journal of Gastric Cancer
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• 제6권1호
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• pp.52-56
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• 2006

위암의 근치적 절제를 위해 위절제를 시행할 때, 위절제술 후 위공장 문합술, 위십이지장 문합술, Roux-en-Y 술식 및 소장낭 간치술과 같은 다양한 재건술식이 사용되고 있다. 이러한 위절제 및 재건을 받은 환자가 급성복증을 호소하는 경우, 진단적 접근을 시행하며 재건술식과 관련하여 위장 내 및 복강 내 출혈이라든지 십이지장 단단부의 누출, 잔존위의 괴사, 문합부 누출, 복강 내 농양 형성, 덤핑증후군, 수입각 및 수출각의 폐색, 문합부 후방탈장, 담도계 결석 등의 다양한 가능성을 염두에 두게 된다. 그러나 저자들은 1개월 전 전정부 조기위암으로 위아전절제술 및 위공장 문합술을 받은 69세 남자환자가 수술 후 1개월만에 급성 상복부 동통을 주소로 내원하여 시행한 수술 전 검 사상 다량의 후복막 내 유리공기음영이 확인되어 개복한 결과 2부 십이지장에 생긴 가성 게실의 천공을 발견하고 일차봉합 및 배액술 시행 후 건강한 상태로 퇴원하였던 한 증례였다. 십이지장 게실 사후 부검 연구의 약 $11{\sim}22%$에서 발견되는 비교적 흔한 질환으로 위절제 및 재건술 후 급성 복증과 후복막강의 유리공기음영을 동반하는 경우라면 한번쯤 감별 진단하여야 할 것으로 여겨지는 바이다.

• Journal of Gastric Cancer
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• 제3권2호
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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.

• Advances in pediatric surgery
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• 제11권2호
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• pp.186-191
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• 2005

A 10-year-old-girl was referred to our hospital due to abdominal pain. She underwent Roux-en-Y cystojejunostomy for a choledochal cyst at another hospital at the age of 3 months. Abdominal ultrasonography (USG) and computed tomography (CT) showed type I choledochal cyst and multiple gallbladder stones. Because of severe inflammation and adhesion, partial resection of the choledochal cyst and Roux-en-Y hepaticojejunostomy was performed. Two and one half years later, intermittent abdominal pain, fever, nausea and vomiting occured. Abdominal CT scan showed a polypoid nodular lesion in the remnant of the choledochal cyst and probable metastasis at segment 7 of the liver. The duodenum was obstructed by the mass. Liver biopsy revealed moderately differentiated adenocarcinoma. A palliative gastrojejunostomy was performed to relieve duodenal obstruction. She died of hepatic insufficiency 4 months later.