• Journal of Chest Surgery
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• 제28권10호
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• pp.935-938
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• 1995

Two cases of severe caustic injury of the hypopharynx, esophagus, and stomach are presented. Restoration of digestive continuity was accomplished by retrosternal isoperistaltic interposition of the transverse and left colon on the post-injury 73rd and 66th day respectively. The upper oro-colon continuity was made by a cervical approach, a vertical incision at the posterior hypopharyngeal wall, and interrupted one-layer sutures using 3-0 Dacron suture materials. The distal continuity was made by colojejunostomy between the transposed colon and proximal jejunum. There was no event after the operation in both cases. The posterior vertical hypopharyngotomy and hypopharyngocolostomy at the early post-injury period may be the preferred procedure to obtain normal deglutition in patients with esophageal stricture associated with hypopharyngeal injury.

• Journal of Chest Surgery
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• 제5권1호
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• pp.57-60
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• 1972

Esopkageal rupture is one of the rarest disease. Mackler described that esophageal rupture was differentiated from esophageal perforation, the perforation is produced by esophagoscopy, and continuous erosion, such as esophagitis,gastric reflux, hiatal hernia and malignant neoplasm of the esophagus, the rupture is occurred by severe vomiting, cough and strong positive pressure into the esophageal lumen. Since,at first Boerhaave reported the esophageal rupture due to severe vomiting in 1742, several case reports of esophageal rupture have been in the literatures. Authors reported a case of the esophageal rupture due to explosion of gasoline in 50 year old female. The rupture occurred a longitudinal rent on the left posterolateral aspect of lower one third of esophagus and accompanied wlth second degree burn on the entire face and neck. The treatment consists of immediate thoracotomy in order to drainage of pyothorax and gastrostomy for nutritional problem, but patient expired because of septicemia probably due to uncontrollable empyema of thorax on 45th admitted day.

• Journal of Chest Surgery
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• 제18권4호
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• pp.800-805
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• 1985

Bronchogenic cysts are a congenital cystic lesion which are usually found within the lung parenchyme or mediastinum. Two cases of bronchogenic cysts were presented and related literatures were reviewed. The first case of bronchogenic cyst was located in the wall of the esophagus. Preoperatively, this case was thought duplication cyst of esophagus, but postoperative microscopic examination showed the tumor was a bronchogenic cyst with respiratory epithelium. The second case had double cysts; one in the superior and posterior mediastinum, the other in the lung parenchyme. The cyst in the mediastinum was extirpated and the other cyst in the lung was removed by right upper lobectomy. Postoperative course were uneventful in both patients.

• Journal of Chest Surgery
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• 제48권1호
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• pp.40-45
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• 2015

Background: Surgical enucleation is the treatment of choice for esophageal submucosal tumors (SMTs) with symptomatic, larger, or ill-defined lesions. The enucleation of SMTs has traditionally been performed via thoracotomy. However, minimally invasive approaches have recently been introduced and successfully applied. In this study, we present our experiences with the thoracotomic and thoracoscopic approaches to treating SMTs. Methods: We retrospectively reviewed 53 patients with SMTs who underwent surgical enucleation between August 1996 and July 2013. Demographic and clinical features, tumor-related factors, the surgical approach, and outcomes were analyzed. Results: There were 36 males (67.9%) and 17 females (32.1%); the mean age was $49.2{\pm}11.8$ years (range, 16 to 79 years). Histology revealed leiomyoma in 51 patients, a gastrointestinal stromal tumor in one patient, and schwannoma in one patient. Eighteen patients (34.0%) were symptomatic. Fourteen patients underwent a planned thoracotomic enucleation. Of the 39 patients for whom a thoracoscopic approach was planned, six patients required conversion to thoracotomy because of overly small tumors or poor visualization in five patients and accidental mucosal injury in one patient. No mortality or major postoperative complications occurred. Compared to thoracotomy, the thoracoscopic approach had a slightly shorter operation time, but this difference was not statistically significant ($120.0{\pm}45.6$ minutes vs. $161.5{\pm}71.1$ minutes, p=0.08). A significant difference was found in the length of the hospital stay ($9.0{\pm}3.2$ days vs. $16.5{\pm}5.4$ days, p<0.001). Conclusion: The thoracoscopic enucleation of submucosal esophageal tumors is safe and is associated with a shorter length of hospital stay compared to thoracotomic approaches.

• Journal of Gastric Cancer
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• 제21권2호
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• pp.132-141
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• 2021

Purpose: Intracorporeal esophagojejunostomy during reduced-port gastrectomy for proximal gastric cancer is a technically challenging technique. No study has yet reported a robotic technique for anastomosis. Therefore, to address this gap, we describe our reduced-port technique and the short-term outcomes of intracorporeal esophagojejunostomy. Materials and Methods: We conducted a retrospective review of patients who underwent a totally robotic reduced-port total or proximal gastrectomy between August 2016 and March 2020. We used an infra-umbilical Single-Site^® port with two additional ports on both sides of the abdomen. To transect the esophagus, a 45-mm endolinear stapler was inserted via the right abdominal port. The common channel of the esophagojejunostomy was created between the apertures in the esophagus and proximal jejunum using a 45-mm linear stapler. The entry hole was closed with a 45-mm linear stapler or robot-sewn continuous suture. All anastomoses were performed without the aid of an assistant or placement of stay sutures. Results: Among the 40 patients, there were no conversions to open, laparoscopic, or conventional 5-port robotic surgery. The median operation time and blood loss were 254 min and 50 mL, respectively. The median number of retrieved lymph nodes was 40.5. The median time to first flatus, soft diet intake, and length of hospital stay were 3, 5, and 7 days, respectively. Three (7.5%) major complications, including two anastomosis-related complications and a case of small bowel obstruction, were treated with an endoscopic procedure and re-operation, respectively. No mortality occurred during the study period. Conclusions: Intracorporeal esophagojejunostomy during reduced-port gastrectomy can be safely performed and is feasible with acceptable surgical outcomes.

• 한국임상수의학회지
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• 제22권3호
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• pp.281-283
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• 2005

A 3-month-old male, Cocker Spaniel with persistent regurgitation immediately after weaning and stunted growth was referred. Radiographic findings on the lateral view include ventral deviation of the thoracic trachea caused by draping of the dilated esophagus and a distinct interface of the dorsal wall of the esophagus silhouetting with the cranial thoracic hypaxial muscles. On the ventrodorsal view, the cranial mediastinum was widened with soft tissue opacity. The trachea was deviated to the right. In an esophagogram, the segmental dilation of the esophagus with constriction of the lumen just cranial to the heart base was identified. In a fluoroscopic examination, the contrast medium was massively accumulated in the cranial portion of the constricted esophagus. At surgery, it was confirmed that the esophageal tract was constricted at the cranial to the base of the heart by aberrant right subclavian artery. It was ligated and divided surgically. Current state of the referred is maintained normal condition from the surgical repair.

• Journal of Chest Surgery
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• 제29권9호
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• pp.1003-1009
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• 1996

식도위장문합술에서 주로 사용되는 원형기계를 사용하는 문합술은 편리하며 누공발생률이 적은 술기이나 문합부의 협착이 잘 생기며 이는 문합기가 작은 경우에 발생빈도가 높다. 경부에서 식도위장문합시 기계문합식으로 편리하게 수술하면서 협착을 방지하는 수술수기로흉강경용 봉합기를 사용하는 방법을 고폰하여서 임상적용한 결과를 보고한다. 식도암 환자 13례에서 식도재건술에 흉강경용 봉합기를 사용하여 경부식도위장 문합을 하였고 수술후 평균 8개월 관찰하여 문합부의 헙착발생을 관찰하였다. 식도암환자 13례중 수술후 사망한 1례를 제외한 12례중 1례에서 술후 위장궤사에 의한 누공이 있었고, 11례에서는 협착증상 없었다. 경부식도위장 문합술에서 흉강경용 봉합기를 사용한 결과 수술이 편리하고 협착 및 누공의 발생률은 매우 낮다. 흉강경용 봉합기 문합술식은수술이 간편하고,작은 내경의 식도와위장문합에서 생기는문합부의 협착을 방지할 수 있는 수술로 경부의식도장관문합의 변형술식으로 적용할 수 있다.

• Journal of Korean Neurosurgical Society
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• 제48권5호
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• pp.406-411
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• 2010

Objective : Esophageal/hypopharyngeal injury can be a disastrous complication of anterior cervical surgery. The amount of hypopharyngeal wall exposure within the surgical field has not been studied. The objective of this study is to evaluate the chance of hypopharyngeal wall exposure by measuring the amount of axial rotation of the thyroid cartilage (ARTC) and posterior projection of the hypopharynx (PPH). Methods : The study was prospectively designed using intraoperative ultrasonography. We measured the amount of ARTC in 27 cases. The amount of posterior projection of the hypopharynx (PPH) also was measured on pre-operative CT and compared at three different levels; the superior border of the thyroid cartilage (SBTC), cricoarytenoid joint and tip of inferior horn of the thyroid cartilage (TIHTC). The presence of air density was also checked on the same levels. Results : The angle of ARTC ranged from $-6.9^{\circ}$ to $29.7^{\circ}$, with no statistical difference between the upper and lower cervical group. The amount of PPH was increased caudally. Air densities were observed in 26 cases at the SBTC, but none at the TIHTC. Conclusion : Within the confines of the thyroid cartilage, surgeons are required to pay more attention to the status of hypopharynx/esophagus near the inferior horn of the thyroid cartilage. The hypopharynx/esophagus at the TIHTC is more likely to be exposed than at the upper and middle part of the thyroid cartilage, which may increase the risk of injury by pressure. Surgeons should be aware of the fact that the visceral component at C6-T1 surgeries also rotates as much as when the thyroid cartilage is engaged with a retractor. The esophagus at lower cervical levels warrants more careful retraction because it is not protected by the thyroid cartilage.

• Journal of Chest Surgery
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• 제16권4호
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• pp.584-593
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• 1983

Esophageal reconstruction was performed in 344 patients with irreversible stricture of the esophagus resulting from caustic burns at National Medical Center from 1959 to 1982.There were 113 males and 231 females, and ranging from 2.5 to 58 years of age, and mean age was 26.5 years, and 25 cases were less than 10 years old. Caustic materials were 286 [83.2%] alkali and 50[14.5%] acid. The most frequent stricture site was upper thoracic esophagus as 56.7%, and the next was cervical as 31.4%, and lower, 11.9%. The stomach was involved in 10.8% totally, and hypopharyngeal stricture was also noticed in 3.2%, and in 3 cases, hypopharyngeal reconstruction was needed due to extensive scar change. In 329 of total 344 cases, colon interposition was performed without resection of the strictured esophagus except 4 cases which were complicated T-E fistula or perforation, and most of them, about 10-15 cm of terminal ileum with right half of the colon was used as the graft. The left colon with anti-peristalsis was used as graft only in 30 cases. The most common postoperative complication was anastomotic leak as 16.7% of total cases, and it was 12.5% from neck, 3.3% from ileocolostoma and 0.9% from cologastrostoma. Next common complication was neck stenosis [8.8%], aspiration pneumonia [6.4%], and graft necrosis [3.9%] in order. Overall operative mortality was 5.5% [14/329], and main causes of death were graft necrosis, sepsis due to anastomotic leak, gastric bleeding, and intestinal obstruction. Besides of colon interposition, according to shape or level of the stricture, plastic repair or segmental resection and direct anastomosis was done in 9, and 1 of them were complicated stenosis at the anastomotic site. In lower stricture, esophagogastrostomy was done in 10 cases, and 1 case expired due to hepatitis, and anastomotic stenosis was occurred in 2 cases at 1.5 months and 2.4 years later. During follow-up of 298 cases colon interposition from 6 months to 22 years, 82.6% was excellent, and 2.9% was complained of mild discomfort, and 4 cases were dead laterly, but 3 of them were not related to reconstruction.

• Journal of Chest Surgery
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• 제21권6호
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• pp.1060-1070
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• 1988

Since Jan. 1957, 142 cases of benign esophageal stricture, 55 males and 87 females, were managed in our hospital, and their ages ranged from 3 to 77 years. old[mean 31.2yrs]. The most common cause was caustic burns and they all complained dysphagia and some loss of weight, general malaise and substernal pain, which usually appeared in 1 month to 1 year after ingestion of corrosive agents. The mid 1/3 of the thoracic esophagus was the most prevalent portion[29%] but rather evenly distributed along the entire esophagus. Operations were done on 129 patients, of whom 50 patients had ECG[esophagocologastrostomy], 5 PCG[pharyn-gocologastrostomy], 34 EG[esophagogastrostomy], 4 EJG[esophagojejunogastrostomy], 3 PG[pharyngogastrostomy], 2 esophageal end to end anastomosis and 31 Gastrostomy. There were 6 deaths in the postoperative period, so its operative mortality was 4.7%, among them 3 were ECG cases, 2 EG and 1 EJG. And 34 complications occurred so it recorded 24% complication rate. and in details in ECG 46%, PCG 60%, EG 17.6%, EJG 25%, and PG 33%. When we reviewed periodic variations, the mortality rate of the first 20 yrs. period was 6.9%, next 10yrs. 2.6% and now for last 2yrs non.