• Journal of Gastric Cancer
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• 제13권1호
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• pp.34-43
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• 2013

Purpose: The intracorporeal reconstruction after laparoscopic gastrectomy can minimize postoperative pain, and give better cosmetic effect, while it may have technical difficulties and require the learning curve. This study aimed to analyze the surgical outcome of intracorporeal reconstruction according to the surgeon's experience comparing with extracorporeal procedure. Materials and Methods: From January 2009 to September 2011, intracorporeal reconstruction in laparoscopic surgery for gastric cancer was performed for 71 patients (Intra group). During same period, 231 patients underwent laparoscopy-assisted gastrectomy (Extra group). These patients were classified into initial (1st to 20th case of intra group), intermediate (21th to 46th case), and experienced (after 47th case) phases. Results: Intracorporeal procedures included 35 cases of Billroth-I, 30 Billroth-II and 6 Roux en Y reconstructions. In the initial phase, operation time (P=0.022) were significantly longer for the patients of intra group than them of extra group. Although the difference was not significant, the length of hospital stay was longer and complication rate was higher in the intra group. In intermediate and experienced phases, there was no difference between two groups in operation time and hospital stay. In these phases, complication rate was lower in the intra group than the extra group (3.9% versus 9.7%). The pain scale was significantly lower post operation day 5 in the intra group. Conclusions: Intracorporeal reconstruction after laparoscopic distal gastrectomy was feasible and safe, and the technique was stabilized after 20th case if the surgeon has sufficient experiences when we compared it with extracorporeal reconstruction.

• 대한영양사협회학술지
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• 제7권1호
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• pp.72-79
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• 2001

The purpose of this study is to investigate the dietary intakes and nutritional status in total gastrectomized patients. We assessed the nutritional status by dietary intake, anthropometric data and biochemical data. And we also checked the subjective postprandial symptoms and gastrofiberscopy to detect the reflux esophagitis in 22 patients who were free of tumors for more than 1 year after total gastrectomy by the three different reconstruction methods(Loop esophagojejunostomy with A-loop tie/ Roux-en-Y esophagojejunostomy/Roux-en-Y esophagojejunostomy with Paulino pouch). Any patients were not in malnutrition status in respect to biochemical data. By assessing the dietary intake, the average daily calorie intake was 1848.2$\pm$440.2kcal, it was 105.9$\pm$23.8% of energy requirement. But there was weight loss in 21 patients of 22 patients after operation and the weight loss was 12.8% of preoperative weight(61.0$\pm$7.9 vs. 53.5$\pm$6.7kg, preoperatively vs. at the time of study). This may suggest that continuous nutritional care is necessary after total gastrectomy to promote sufficient calorie intake, keeping good nutritional state. There were no significant differences between the methods of reconstruction and dietary intakes or nutritional status. Endoscopic esophagitis was more frequently found in patients of loop esophagojejunostomy than any other reconstruction methods(p<0.001), but it didn't show any effect on the dietary intakes.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제3권2호
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• pp.217-221
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• 2000

저자들은 복부종괴가 촉진되고 간헐적 복부 동통을 주소로 내원한 14세 여아에서 복부 컴퓨터 단층 촬영과 조직검사로 고형 및 유두상 종양으로 진단하고 종괴절제술 및 Roux-en-Y 췌장공장문합술(pancreaticojejunostomy)로 치료한 환아 1례를 경험하였기에 보고하는 바이다.

• 대한영양사협회학술지
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• 제17권2호
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• pp.206-215
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• 2011

Currently, metabolic surgery (Laparoscopic Roux-en-Y gastric bypass, LRYGB) has an important role and should be recommended as an intervention in the management of obese patients with type 2 diabetes mellitus (T2DM). A successful outcome of surgery requires medical nutrition therapy. Therefore, we performed a retrospective study on 25 patients with T2DM who underwent LRYGB at Yeouido St. Mary's Hospital from October 2008 to May 2010. The patients were followed up for an average of 6 months after surgery (range: 2~19 months). Diabetes was resolved in 80% of the patients. Percentage of excess weight loss was (%EWL) was 56.2%. After surgery, fasting blood sugar (FBS) and HbA1c were significantly reduced (123 mg/dl, A1c 6.7%, P<0.001) and triglyceride was also significantly reduced to 107.6 mg/dl (P<0.05). As diets of the patients progressed from liquid to soft to regular diet, energy, carbohydrates, and fat intakes increased significantly (P<0.001). But protein intake did not change significantly. Nutrient intake of the patients after the surgery was significantly lower than the recommended diet for the non-surgery group. Patients experienced side-effects related to the diets after surgery, including hair-loss (76%), smelly gas (52%), vomiting (48%), etc. A significantly positive correlation was observed between vomiting and FBS (P<0.001). There was a significant relationship between side effects and the amount of nutrient intakes. Therefore, guide patients to a diet progression with treatment to minimize side effects, especially vomiting. And monitor their dietary life to be healthy and not to regain weight until remission of T2DM.

• Journal of Gastric Cancer
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• 제17권2호
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• pp.99-109
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• 2017

Purpose: In this study, we aimed to evaluate the rarely reported long-term nutritional results of patients with gastric cancer after curative gastrectomy. Materials and Methods: We retrospectively reviewed the prospectively collected medical records of 658 patients who underwent radical gastrectomy with curative intent for gastric cancer from January 2008 to December 2009 and had no recurrences. All patients were followed for 5 years. Nutritional statuses were assessed using measurements of body weight, serum hemoglobin, total lymphocyte count (TLC), protein, albumin, cholesterol, and nutritional risk index (NRI). Results: Patients who underwent total gastrectomy had lower body weights, hemoglobin, protein, albumin, and cholesterol levels. TLC and NRI values after the first postoperative year (P<0.05), and lower hemoglobin and NRI values during the fifth postoperative year than patients who underwent distal gastrectomy (P<0.05). Patients who received adjuvant chemotherapy after gastrectomy had lower hemoglobin, protein, albumin, and cholesterol levels. TLC and NRI values during the first postoperative year, than those who underwent gastrectomy only (P<0.05). Regarding post-distal gastrectomy reconstruction, those who underwent Roux-en-Y had lower cholesterol levels than did those who underwent Billroth-I and Billroth-II reconstruction at the first and fifth years after gastrectomy, respectively (P<0.05). Conclusions: Patients undergoing total or distal gastrectomy with Roux-en-Y anastomosis or adjuvant chemotherapy after surgery should be monitored carefully for malnutrition during the first postoperative year, and patients undergoing total gastrectomy should be monitored for malnutrition and anemia for 5 years.

• Journal of Gastric Cancer
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• 제22권3호
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• pp.220-234
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• 2022

Purpose: The incidence of adenocarcinoma of the esophagogastric junction (AEG) has increased in recent years, and the optimal surgical strategy for AEG remains highly controversial. We aimed to evaluate the safety and efficacy of proximal gastrectomy with double-tract reconstruction (PG-DT) for the treatment of patients with AEG. Materials and Methods: We retrospectively analyzed patients with Siewert type II/III AEG between January 2013 and July 2018. Clinicopathological characteristics, survival, surgical outcomes, quality of life (QOL), and nutritional status were compared between the PG-DT and total gastrectomy with Roux-en-Y anastomosis (TG-RY) groups. Results: After propensity score matching, 33 patients in each group were analyzed. There were no statistical differences between the 2 groups in terms of disease-free survival and overall survival. The surgical option was not an independent prognostic factor based on the multivariate analysis. In addition, no differences were found in terms of surgical complications. There were no significant differences in QOL assessed by the Visick grade, Gastrointestinal Symptom Rating Scale, or endoscopic findings. Furthermore, the long-term nutritional advantage of the PG-DT group was significantly greater than that of the TG-RY group. Conclusions: PG-DT is a safe and effective procedure for patients with local Siewert type II/III AEG, regardless of the TNM stage.

• Clinical Endoscopy
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• 제55권6호
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• pp.736-741
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• 2022

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass anatomy is a well-documented challenge. Traditionally, this problem has been overcome with adjunctive techniques, such as device-assisted ERCP, including double-balloon or single-balloon enteroscopy and laparoscopy-assisted transgastric ERCP. Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a novel technique that enables access to the ampulla using a duodenoscope without surgical intervention and has shown high clinical and technical success rates in recent studies. However, this approach is technically demanding, necessitating a thorough understanding of the gastrointestinal anatomy as well as high operator experience. In this review, we provide a technical overview of EDGE in parallel with our personal experience at our center and propose a simple algorithm to select patients for its appropriate application. In conjunction, the outcomes of EDGE compared with those of device-assisted and laparoscopy-assisted transgastric ERCP will be discussed.

• 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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• 제8권2호
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• pp.97-103
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• 2008

목적: 분문부 위선암의 치료는 아직까지는 근치적 수술이 원칙이고 특히 식도 침윤을 갖는 type II 분문부 위선암은 충분한 절제연을 확보하기 위한 노력이 필요하다. 식도 침윤정도에 따라서 개흉과 개복을 통해 식도-위 절제를 하고 식도 대체술을 하는데, 그 중 저자들은 대장간치의 적응과 치료성적 등을 함께 알아 보고자 하였다. 대상 및 방법: 1994년 1월부터 2006년 12월까지 연세대학교 의과대학 외과학 교실에서 저자에게 위암으로 수술을 받은 1,087명의 환자 중 type II 분문부 위선암으로 좌 또는 우 흉복부 개복과 경복부 절개(경열공)를 이용해 근치적 식도-위절제술을 하고 식도 대체술로 좌측 대장을 간치한 환자 10예를 대상으로 같은 type으로 Roux-en-Y를 받은 환자들과 후향적으로 비교 분석 하였다. 결과: 남녀가 각각 9명, 1명 이었고 중간 연령은 52.5세(16~72세), 수술시간은 $449.00{\pm}87.39$ (SD)분이었고 평균 재원일수는 $20.60{\pm}6.73$ (SD)일이었다. 식도-위 동시성암은 1예가 있었고, 종양으로부터 근위부 절제연까지의 거리는 $6.56{\pm}3.65cm$였으며 종양의 크기는 $9.90{\pm}3.97cm$였는데 Roux-en-Y군의 값들과 차이를 보였다(sex and age matched analysis, P=0.019, P=0.046). 수술 사망은 없었고, 술 후 합병증은 2예가 있었는데 각각 문합부 협착과 폐기흉이었다. 사망은 총 4예가 있었고 수술 후 환자 대부분(83%)은 체중이 늘어 체중증가가 최대 16 kg까지 있었다. 결론: 식도 침윤을 하는 type II 분문부 위암에서 크기가 매우 큰 경우는 근치적 식도-위 절제술이 필요하다. 식도 대체 장기로는 좌측 대장을 이용 할 수 있는데 수술 시간이 길지만, 근치적 수술에 유리하고 식도-공장 문합술에 비해 수술 합병증이 많지는 않아, 재건술로 좌측 대장을 이용하는 방법도 가치가 있다고 생각한다.

• Journal of Gastric Cancer
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• 제20권2호
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• pp.225-231
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• 2020

Gastric cancer is a rare condition affecting patients with familial adenomatous polyposis (FAP). The mainstay of treatment is total gastrectomy. Since duodenal cancer is the most common cause of death after total colectomy in FAP, endoscopic surveillance for duodenal cancer is mandatory. Here, we describe the use of an isoperistaltic jejunal loop interposition technique to reconstruct the digestive tract after total gastrectomy in 2 patients with FAP. There were no early or late complications. Both patients are still alive and in good clinical condition. They did not experience weight loss or symptoms of dumping syndrome. Duodenal endoscopic surveillance after this technique was easier than after the classical Roux-en-Y reconstruction. Hence, regular follow-up was possible for both patients.