• Journal of Chest Surgery
• /
• v.29 no.6
• /
• pp.672-674
• /
• 1996

Chylothorax is a rare, but well-recognized complication of cardiothoracic surgery and operations in the region of the esophageal or aortic diaphragmatic hiatus. Especially, in nutritionally depleted patients requiring esophagectomy for benign or malignant diseases, it is a potentially life-threatening disorder that has profound respiratory, nutritional and immunologic co sequences . We have experienced a case of chylothorax after transhiatal esophagectomy in benign esophageal stricture. The diagnosis of chylothorax was confirmed after feeding through the jejunostomy tube by the change of the character of pleural effusion and high triglyceride level on the 5th postoperative day. On the thirteenth postoperative day, supradiaphragmatic thoracic duct ligation was performed through right thoracotomy. We could remove the chest tube on the 22th postoperative day, and the patient is being followed-up at out patient clinic without complications.

• Journal of Chest Surgery
• /
• v.29 no.12
• /
• pp.1392-1397
• /
• 1996

Over the past two years the free jejunal transfer have been used in 7 consecutive patients to restore alimentary tract continuity artier the resection of esophagus. Six patients had squamous cell carcinomas and one had esophageal stricture . The patients underwent partial esophagectomy with modified radicAl neck dissection or mediastinal Iymph node dissection. The microvascular anastomosis was performed to the neck vessels in 4 patients and to the in ercostal vessels in 3 patients. Postoperative complications were graft necrosis in one patient, and a temporary anastomotic leakage with spontaneous closure in one patient. Reconstruction of the esophagus was successful in 6 of 7 patients. We emphasize that esophagectomy followed by transplantation of a free jejunal transfer is suitable for esophageal carcinoma or intractable esophageal stricture, and involvement of the midesophagus is not a contraindication to the use of the free Jejunal transfer.

• Journal of Chest Surgery
• /
• v.35 no.6
• /
• pp.495-499
• /
• 2002

Plummer-Vinson syndrome(Paterson-Kelly syndrome) is characterized by dysphagia due to upper esophageal or hypopharyngeal web, iron deficiency anemia, and atropic oral and glossal mucosa. This syndrome is usually known as precancerous lesion that develops into postcricoid carcinoma. Universally, the clinical manifestations of this syndrome were markedly improved after oral iron replacement therapy or endoscopic balloon or electrocautery treatment. 63 year-old woman was received a short segment, free jejunal transfer to be released from esophageal stricture. After the operation, the stenotic lesion proved to be Plummer-vinson syndrome with carcinoma in situ by pathologic study.

• Journal of Chest Surgery
• /
• v.40 no.9
• /
• pp.651-654
• /
• 2007

Tracheoinnominate artery fistula (TIF) is a very rare complication that can happen after long standing tracheostomy or insertion of an endotracheal tube and its mortality is very high. This condition requires early diagnosis and urgent management because of the life threatening results from tracheal obstruction or hypovolemic shock that is caused by massive bleeding. We report here on a case of successful tracheoplasty with using the costal cartilage, including the perichondrium, in a patient with laryngeal stricture, and this was done to preserve the trachea for the following operation to relieve the laryngeal stricture.

• Journal of Gastric Cancer
• /
• v.19 no.3
• /
• pp.344-354
• /
• 2019

Purpose: No standard technique has been established for esophagojejunal anastomosis during laparoscopic total gastrectomy (LTG) for gastric cancer owing to the technical difficulty and high complication rate of this procedure. This study was performed to compare the short-term outcomes of circular and linear stapling methods after LTG. Materials and Methods: A total of 106 patients treated between July 2010 and July 2018 were divided into 2 groups according to the following anastomosis procedures: hemi-double-stapling technique (HDST; circular stapling method; group C, n=77) or overlap method (linear stapling method; group L, n= 29). The clinicopathological features and postoperative outcomes, including complications, were analyzed. Multivariate analysis was performed using a logistic regression model to identify the independent risk factors for anastomotic complications. Results: The incidence of anastomotic complications was significantly higher in group C than in group L (28.0% vs. 6.9%, P=0.031). The incidence of anastomosis leakage did not differ between the groups (6.5% vs. 6.9%, P=1.000). However, anastomosis stricture occurred only in group C (13% vs. 0%, P=0.018). Multivariate analysis showed that the anastomosis type was significantly related to the risk of anastomotic complications (P=0.045). Conclusions: The overlap method was superior to the HDST with respect to anastomotic complications, especially anastomosis stricture.

• Clinical Endoscopy
• /
• v.56 no.6
• /
• pp.726-734
• /
• 2023

Background/Aims: Endoscopic stenting for stricturing Crohn's disease (CD) is an emerging treatment that achieves more persistent dilatation of the stricture over time than endoscopic balloon dilatation (EBD). We aimed to explore the efficacy and safety of stenting for the treatment of CD strictures. Methods: A systematic electronic literature search was performed (PROSPERO; no. CRD42022308033). The primary outcomes were technical success, efficacy, complication rate, and the need for further interventions due to reobstruction. The outcomes of partially covered self-expanding metal stents (PCSEMS) with scheduled retrieval after seven days were also analyzed. Results: Eleven eligible studies were included in the review. Overall, 173 patients with CD were included in this study. Mean percentage of technical success was 95% (range, 80%-100%), short-term efficacy was 100% in all studies, and long-term efficacy was 56% (range, 25%-90%). In patients with a scheduled PCSEMS retrieval, the long-term efficacy was 76% (range, 59%-90%), the mean complication rate was 35% (range, 15%-57%), and the major complication rate was 11% (range, 0%-29%). Conclusions: Endoscopic stenting with scheduled PCSEMS retrieval may be considered a feasible second-line treatment for short CD strictures to postpone surgery. However, larger head-to-head prospective studies are needed to understand the role of stenting as an alternative or additional treatment to EBD in CD.

• Clinical and Experimental Pediatrics
• /
• v.52 no.4
• /
• pp.446-452
• /
• 2009

Purpose : This study was performed to demonstrate the usefulness of early endoscopy for predicting the development of stricture following corrosive ingestion in children. Methods : We conducted a retrospective study on 34 children who were brought to Seoul National University Childrens Hospital and Seoul National University Bundang Hospital for corrosive ingestion from 1989 to 2007. Results : The corrosive burns were classified as grade 0 in 8 patients, grade 1 in 2, grade 2a in 7, grade 2b in 13, and grade 3 in 4. There was no significant correlation between the presence of esophageal injury and symptoms including vomiting, dysphagia, and drooling. There was a statistically significant relation between the presence of oropharyngeal injury and esophageal injury (P=0.014). There were no complications including hemorrhage and perforation related to endoscopy. Strictures of the esophagus or the stomach developed in 12 patients (36.4%). Esophageal stricture was observed in 11 patients and pyloric stenosis in 1 patient. The endoscopic grade of mucosal injury was significantly related to the frequency of development of esophageal stricture (P=0.002). Two of eleven patients with esophageal stricture responded to repeated dilation. The remaining seven patients underwent surgery. Conclusion : Early esophagogastroduodenoscopy is not only a safe and useful diagnostic tool for children with accidental caustic ingestion but also a necessity for determining the degree and the extent of caustic burns and for predicting the development of late complications.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.3 no.1
• /
• pp.1-8
• /
• 2000

Purpose: This study was undertaken to evaluate the clinical features and complication such as esophageal stricture in children with corrosive esophagitis. Methods: We retrospectively reviewed medical records of 31 children who accidentally ingested corrosive materials and visited to emergency room of Chonnam National University Hospital from Jan. 1992 to Dec. 1999. Twenty-one children were examined by upper gastrointestinal (UGI) endoscopy to evaluate location and severity of caustic injury. Results: 1) Among 31 patients, there were 20 males and 11 females and the ratio of male to female was 2:1. Average age at diagnosis was 2.3 years (12 months to 9.8 years). Twenty-seven (87.1%) patients were accidentally ingested vinegar. 2) Initial presenting symptoms were dysphagia (54.8%), vomiting (48.3%), chemical burn on lips and skin (45.2%), excessive salivation (45.2%), coughing and respiratory grunting (32.3%) and aspiration pneumonia (9.8%). 3) UGI endoscopic examination showed caustic injury in 17 children: grade I in 8, grade II in 7 and grade III in 2. The region of caustic injury was proximal esophagus in 5, distal esophagus in 3, entire esophagus in 9 and stomach in 6. 4) Corrosive esophageal strictures developed in 6 children (19.4%) and gastric outlet stricture in 1 (3.2%). All of them showed grade II or III caustic injury on endoscopic examination. Conclusion: The development of esophageal stricture was related to the severity of the caustic injury. Early UGI endoscopic examination in caustic ingestion seems to be useful for prediction of development of caustic stricture.

• Journal of Chest Surgery
• /
• v.41 no.5
• /
• pp.625-629
• /
• 2008

Background: When it comes to esophageal cancer operations, the prevalence of anastomotic complications that adversely affect quality of life is related to the type of anastomotic procedure and the operative site. We studied outcomes related to a safe anastomotic method used in Ivor Lewis esophagogastrectomy for preventing anastomotic leakage and stricture formation. Material and Method: Between May 2003 and April 2007, 18 patients with esophageal cancer underwent this type of esophagogastrectomy. Four people were lost to follow-up. There were 17 men (94.4%) and 1 woman. The mean patient age was 61 years (range, $46{\sim}73$ years). Result: The mean follow-up period was 17.2 months (range, $1{\sim}45$ months). There was no anastomotic leakage. There was one benign anastomotic stricture (5.6%) requiring esophageal balloon dilatation, which was accomplished with a 25 mm circular stapler. Conclusion: We experienced relatively good postoperative results using a safe anastomotic method in the Ivor lewis operation for preventing anastomotic complications. These results suggest that this anastomotic method is effective in reducing the incidence of benign anastomotic complications.

• Archives of Plastic Surgery
• /
• v.33 no.4
• /
• pp.407-412
• /
• 2006

Purpose: Various attempts of reconstruction for pharyngoesophageal defects after ablative surgery have been made to restore the function of the pharyngoesophagus. A fabricated tubed radial forearm free flap or free jejunal free flap was used when the width of remnant pharyngeal wall was less than 50% of the normal width. However there are many disadvantages such as stricture, saliva leakage and fistula formation on tubed radial forearm free flap. The jejunal free flap has the problem such as short pedicle, poor tolerance of ischemic time, wet voice and delayed transit of swallowed food due to the uncoordinated contraction. The authors studied the utility of patch-type radial forearm free flap using the remnant posterior pharyngeal wall of the hypopharynx. Methods: Retrospective reviews in Severance Hospital were made on 25 patients who underwent reconstruction surgery with patched radial forearm free flap because of the hypopharyngeal cancer between 1996 and 2005. The patients of Group I had the narrow posterior pharyngeal wall and its width was less than 3centimeters after the tumor was resected. Those of Group II had the partial pharyngectomy and the width of the remnant pharynx was larger than 3 centimeters. Results: Seven patients belonged to the group I and the flap of this group had 100% survival rate. One case of fistula and no swallowing discomfort due to stricture was reported. The Group II including 18 patients also had the 100% flap survival rate. Neither fistula nor stricture was seen but the lower diet grade was checked. Conclusion: The patch type radial forearm free flap using the remnant pharyngeal wall have the advantage of the radial forearm free flap, and furthermore this flap is the safe reconstructive method even if the width of the remnant pharyngeal wall is less than 30% of that of normal pharynx.