• Advances in pediatric surgery
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• v.14 no.2
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• pp.117-124
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• 2008

Children who underwent reparative operations for esophageal atresia (EA) with or without tracheoesophageal fistula (TEF), are confronted with many gastrointestinal or respiratory problems, especially during the early years of life. We reviewed the medical records of 50 patients who underwent repairs of EA with or without TEF at the Division of Pediatric Surgery, Samsung Medical Center, from December 1994 to December 2005. Current status of children was accessed by telephone-interview, but only 27 of them were accessible. Of 50 patients, 3 patients (6 %) were type A, 45 patients (90 %) were type C, and 2 patients (4 %) were type E. The mean interval between primary operation and interview was 5.5 years. The incidences of growth retardation (<10 percentile of height/weight) were 39 % and 21 % during the first 5 years after repairs, respectively. The incidences of dysphagia or gastroesophageal reflux and recurrent respiratory infections were 33 % and 39 %, respectively. However, these problems were likely to improve as the children grew. The incidences of growth retardations (<10 percentile of height/weight) were 11 % and 11 % for the children more than five years postoperative. The incidences of dysphagia or gastroesophageal reflux and recurrent respiratory infections were 22 % and 22 %, respectively. Children with EA with or without TEF are faced with many obstacles. Close observation and adequate treatment for delayed postoperative complications are necessary to improve the quality of life for these children.

• Korean Journal of Bronchoesophagology
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• v.1 no.1
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• pp.136-141
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• 1995

Tracheostomal stenosis after total laryngectomy is a distressing complication which con-tributes significantly to both psychosocial and physical morbidity according to nature and severity in laryngectomee. Sternal stenosis will compromise not only optimal air exchange, crust formation but also the ability to clear tracheobronchial secretion, so pneumonia and atelectasis will develop. Having a number of procedure recommended for correction of such stenosis with limited results. We developed new technique which is based on tracheal advancement flap had been ap-plied to 12 patients, successfully. We think that total or partial tracheal advancement flap technique Is useful for widening the stoma and advantages of this method are following. 1. Simple technique. possible under local anesthesia 2. Healthy tracheal ring facilities width control 3. Less chance of refractory scar stenosis 4. Tracheoesophageal shunt can be constructed after the partial advancement flap.

• Advances in pediatric surgery
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• v.14 no.1
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• pp.21-26
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• 2008

There is significant morbidity and mortality associated with the combination of esophageal atresia (EA) and duodenal atresia (DA). Nevertheless, the management protocol for the combined anomalies is not well defined. The aim of this study is to review our experience with the combined anomalies of EA and DA. From May 1989 to August 2006, seven neonates were diagnosed as EA with DA at Asan Medical Center. In all cases, the type of EA was proximal EA and distal tracheoesophageal fistula (TEF). The diagnosis of DA was made in theprenatal period in 1, at birth in 4, 4 days after birth in 1 (2 days after EA repair) and at postmortem autopsy in 1. Except the one case where DA was missed initially, primary simultaneous repair was attempted. DA repair with gastrostomy followed by EA repair in 2, EA repair followed by DA repair without gastrostomy in 2, and TEF ligation followed by DA repair with gastrostomy in 1. There were two deaths. One baby had a large posterolateral diaphragmatic hernia, and operative repair was not attempted. The other infant who had a TEF ligation and DA repair with gastrostomy expired from cardiac failure due to a large patent ductus arteriosus. Simultaneous repair of EA and DA appears to be an acceptable management approach for the combined anomalies, but more experience would be required for the selection of the primary repair of both anomalies.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.25 no.6
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• pp.453-460
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• 2022

Purpose: Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is a congenital anomaly that can cause frequent digestive and nutritional problems, even after repair. The most common complication is anastomotic stricture, for which reoperation or balloon dilatation is performed. This study aimed to evaluate the postoperative complications of EA and the role of endoscopic balloon dilatation (EBD) in cases of anastomotic stricture. Methods: We retrospectively analyzed patients diagnosed with EA with or without TEF between January 2000 and February 2021. Patients' baseline characteristics, associated anomalies, and postoperative complications were reviewed. Results: Among 26 patients, 14 (53.8%) were male, 12 (46.2%) had coexisting anomalies, and the median follow-up was 6.1 years (range, 1.2-15.7 years). In univariate analysis, prematurity, low birth weight, and long-gap EA were associated with postoperative complications in 12 (46.2%) patients. Among the 10 (38.5%) patients with anastomotic stricture, nine (90.0%) required EBD. Regarding the first EBD, it was performed at a median of 3.3 months (range, 1.2-7.6 months) post-repair, while the average patient weight was 4.6 kg. The mean diameter ranged from 3.3 to 9.1 mm without major complications. In univariate analysis, long-gap EA alone was significantly associated with EBD. Conclusion: Approximately half of the patients experienced complications after EA repair. In particular, patients with a long-gap EA had a significantly increased risk of complications, such as anastomotic strictures. EBD can be safely used, even in infants.

• Journal of Chest Surgery
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• v.9 no.2
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• pp.298-310
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• 1976

A clinical analysis was performed on 118 cases of the benign esophageal diseases experienced at Department of Thoracic Surgery, Seoul National University Hospital during 20 year period from 1957 to 1976. Of 118 cases of the benign esophageal diseases, there were 84 patients of esophagenal stenosis, 14 of esophageal perforation, 8 of esophageal atresia, 7 of achalasia, 2 of hiatal hernia, 2 of esophageal foreign body and one of esophageal diverticulum. Fifty-one patients were male and sixty-seven were female, and ages ranged from one day to sixty-four years with peak incidence in the age group of 20 to 29 years. All but one of the esophageal stenosis were caused by corrosive esophagitis and ages ranged from three to sixty-four years with peak incidence in third decade. Main symptoms of the esophageal stenosis were dysphagia, weight loss and chest pain in order and mostly began between one month and one year after ingestion of corrosive agents. Corrosive esophageal stenosis developed most frequently in middle one-third of the esophagus and about one-forth of them were diffuse. Operations were performed on 72 patients of esophageal stenosis of whom 26 patients had esophagocologastrostomy, 21 gastrostomy, 20 esophagogastrostomy, 4 esophagojejunogastrostomy and 2 pharyngogastrostomy. There were 5 deaths in the postoperative period, an operative mortality of 6.9 percent, and 20 patients had one or two complications; eight were anastomotic leaks, 6 gangrenes of replaced loop, 4 wound abscesses and others. The causes of the esophageal perforation were traumatic in 7 cases, caustics in 4 and spontaneous in 3, and the most frequent site of the perforation was lower one-third of the esophagus. Frequent symptoms of the esophageal perforation were pain, fever, dysphagia and dyspnea, and preoperatively there were mediastinitis in 8 cases, empyema in 7, lung abscess in 3 and others. All 14 patients of the esophageal perforation underwent operation: primary closure in 7 cases, drainage in 4, esophagogastrostomy in 2 and 'esophageal diversion in one. There were 4 postoperative deaths and 11 postoperative complications occurred in 7 patients. The duration of symptoms in achalasia was between 3 months and 25 years, with an average duration of 6. 2 years. Frequent symptoms of the achlasia esophagi were dysphagia, regurgitation, pain and weight loss in order. All 7 patients of achlasia underwent modified Heller's operation where 2 patients had complications, restenosis in one and esophageal perforation in another. All 8 patients of congenital esophageal atresia had distal tracheoesophageal fistula and were admitted within 5 days of life, but there were pneumonic consolidation on chest X-ray in patients. Five patients underwent one staged operation with the result of 2 deaths and one anastomotic leak.

• Journal of Chest Surgery
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• v.16 no.2
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• pp.231-242
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• 1983

A clinical study was performed on 75 cases of the esophageal cancer and benign esophageal diseases experienced at Department of thoracic & cardiovascular surgery, School of Medicine, Keimyung University during 3 year period from 1978 to 1982. Of 75 cases of the surgical esophageal diseases, there were 35 patients of the esophageal cancer. 17 patients of benign esophageal stenosis, 10 patients of esophageal perforation, 4 patients of diverticulum. 3 patients of achalasia, 2 patients of congenital T-E fistula, one of upper esophageal web, one of esophageal foreign body, one of leiomyoma and patient of hemangioma. First, esophageal carcinoma was more frequent in men than in women by a ratio of five to one, and the peak incidence occurred in the 5th to 6th decade. Dysphagia was the most common symptom in 88.6 percent of our cases. The tumor was located mostly in the middle & the lower one third [91.4%]. The histological diagnosis was made in 35 cases. The squamous cell carcinoma was the most common [82.9%] and the rest was the adenocarcinoma in the lower one third [17.1%]. Thirty-five cases were operated and resection was feasible in the twenty-five patients [71.4%] with 2 cases of hospital mortality [5.7%]. All but two of the esophageal stenosis were caused by corrosive esophagitis and ages ranged from 7 to 70 years with average age of 32 years. Corrective operations were performed on 17 patients of esophageal stenosis of whom 12 patients had esophagocologastrostomy, 3 patients esophagogastrostomy and in non-corrosive esophageal stenosis one case and esophagoplasty and another case had release of external compression. There was one complication of stenosis of the esophageal perforation were traumatic in five cases, empyema in three cases, caustics in one case and postemetic in one case. 10 patients of the esophageal perforation underwent operation: primary closure in 5 cases, two staged colon interposition in 2, esophagogastrostomy in 1 and closed thoracotomy in 2 cases There were 2 complications of leakage of anastomosis sites in postoperative period. 4 patients of traction type of diverticulum underwent diverticulectomy & 3 patients of achalasia underwent modified Heller`s operation. 2 patients of congenital esophageal atresia had distal tracheoesophageal fistula & underwent one staged operation with the results of one death caused by pneumonia. Upper esophageal web had divulsion through the esophagoscope and foreign body in upper esophagus was removed through cervical esophagotomy. One case of leiomyoma in esophagus had esophagectomy and reconstruction with right colon. And one case of hemangioma in esophagus had esophagectomy & esophagogastrostomy.

• Advances in pediatric surgery
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• v.9 no.1
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• pp.6-11
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• 2003

This study reviews 14 years' experience treating esophageal atresia with special emphasis on the clinical profile and outcome. From May 1989 to February 2003, 65 cases of esophageal atresia (EA) were treated at Asan Medical Center. Boys outnumbered girls 2.4 to 1. Prematutity and low birth weight were 27.7% and 38.5%. Esophageal atresia with distal tracheoesophageal fistula (TEF) was the most common type (87.7%), followed by pure EA and H type fistula. Forty-six patients (70.8%) had one or more associated anomalies, cardiac malformations were the most common. Duodenal atresia was found in 7 cases. There were 6 patients (9.2 %) with VATER cluster. VACTERL cluster was present in 18 patients (27.7%), one of who fulfilled the complete syndrome. Waterston group A, B and C made up 21.5%, 40.0% and 38.5% of the total group. Surgical treatment was attempted in 63 patients and deferred in 2 who had severe associated malformations. For EA with distal TEF, primary esophago esophagostomy was carried out in 51 cases, and division of TEF and gastrostomy in 4 cases and no operation in 2 cases. For pure EA, colonic graft was done in 2 after gastrostomy and esophagostomy, and esophago esophagostomy was performed in 2 after gastrostomy. Two patients with pure EA are waiting for the second operation after gastrostomy. Division of TEF was carried out in 2 cases with H type TEF. The overall survival rate was 76.9%, and survival by Waterston classification was 100% in group A, 80.8% in B and 60.0% in C. Thorough workup for associated anomalies, interdepartmental approach and more careful surgical decision and technique are required to improve the outcome of EA.

• Korean Journal of Radiology
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• v.21 no.10
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• pp.1187-1195
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• 2020

Objective: This study aimed to determine the sonographic features suggestive of extrathyroidal extension (ETE) of thyroid cancers. Materials and Methods: We retrospectively reviewed the sonographic images of 1656 consecutive patients who had undergone thyroidectomy in 2017. The diagnostic performance of sonographic features suggestive of ETE was evaluated using operation and histopathologic reports. Sonographic features for gross ETE to the strap muscle and minor ETE were assessed for thyroid cancer abutting the anterolateral thyroid capsule. Sonographic features for tracheal invasion were assessed according to whether the angle between the tumor and the trachea was an acute, right, or obtuse angle. Sonographic features for recurrent laryngeal nerve (RLN) invasion were assessed based on the association between the tumor and tracheoesophageal groove (TEG) as preserved normal tissue, abutting or protruding into the TEG. Results: ETE was observed in 783 patients (47.3%), including 123 patients with gross ETE (7.4% [strap muscle, n = 97; RLN, n = 24; and trachea, n = 14]) and 660 patients with minor ETE (39.9%). Regarding the diagnosis of gross and minor ETE to the strap muscle, sonographic features of replacement of the strap muscle and capsular disruption showed the highest positive predictive value (75.9% and 58.5%, respectively). Thyroid cancer forming an obtuse angle with the trachea had the highest sensitivity for the diagnosis of tracheal invasion (85.7%), and thyroid cancer protrusion into the TEG showed the highest sensitivity for the diagnosis of RLN (83.3%). Conclusion: Sonography is considered beneficial in the diagnosis of ETE to the strap muscle, trachea, and RLN. Assessment of ETE is important for the accurate staging of thyroid cancer, which in turn determines the extent of surgery or whether active surveillance is appropriate or not.