• Journal of Chest Surgery
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• 제27권12호
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• pp.1052-1055
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• 1994

Congenital esophageal atresia without tracheoesophageal fistula which called isolated esophageal atresia is a very rare entity and the neonate classified as category C by Waterston`s classification has high mortality rate. We experienced a case of isolated esophageal atresia. This patient was a male with 1,750gm in body weight and had been suffered from bilateral pneumonia. The patient was managed with staged operation. Feeding gastrostomy was made as the first intervention and delayed primary anastomosis was performed 3 months later. The postoperative course was uneventful and he was discharged on the 22nd postoperative day.

• Journal of Chest Surgery
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• 제27권1호
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• pp.68-71
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• 1994

A tracheo-esophageal fistula following from blunt chest trauma is one of less common lesion and few guidelines are available to direct its optimal management. Herein, we report a 24-year-old man injured in a motor vehicular accident sustained a nonpenetrating double blowout injury of the thorax and large tracheoesophageal fistula occurred. Tracheal defect required resection and reconstruction, of which the membranous portion underwent closure with borrowed adjacent esophageal wall primarily and substernal left colon interposition was performed 4 weeks later.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1991년도 제25차 학술대회 연제순서 및 초록
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• pp.27-27
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• 1991

저자들은 후두전적출술을 시행한 환자의 음성재활을 위해 식도의 근육과 점막을 이용한 shunt를 만들고 이상적인 shunt의 기능을 위해 shunt의 길이, 직경, 적절한 괄약효과 보강, 음성훈련 요령등에 대해 개 5마리를 이용한 동물실험 및 5례의 임상 적용을 통해 다음과 같은 지식을 얻었기에 문헌 고찰과 아울러 보고하는 바이다. 1. shunt의 협착에 대한 문제는 없었다. 2. 식도측의 입구를 좁혀 줌으로서 기관으로의 흡인을 방지할 수 있었다. 3. Nelaton catheter는 72시간 삽입이 적당했다. 4. 음성훈련은 3주부터 시작함이 적당했다. 5. shunt의 길이는 3 cm가 적당했다.

• Journal of Chest Surgery
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• 제29권2호
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• pp.235-238
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• 1996

후천성 기관식도루는 드문 질환이 지만 생명을 위협하는 병변이며 원인중에는 cuff가 있는 tube를 삽관하여 부적절한 관리하에 장기간 인공호흡기 치료를 한 환자에서 발생하는 경우가 가장 많다. 손상의 기전은 cutt에 의해 기관벽에 압력이 가해져서 허혈성 손상과 더불어 염증성 반응이 더해져 압박된 식도와 비정상적 교통이 생기는 것으로 여겨지고 있다. 환자는 25세된 임산부로 중이염의 합병증으로 세균성 뇌막염이 발생하여 장기간의 인공호흡기 치료중 갑작스런 피하기종과 종격동기종이 발생하여 기관지 경과 CT를 이용해 기관식도루가 발생 했음을 확인후 본과에서 수술적 치료를 시행하였다. 수술은 자동봉합기로 기관의 손상부위를 봉합하고 식도 부위는 vlcyl과 Prolene으로 내외층을 단순봉합하였으며 기관과 식도사이에 흉쇄유돌근 절편을 끼워 넣었다. 수술 후 10일째 식도조영술로 기관식도룬가 완전복구되고 식도기능이 정상임을 확인하였으며 퇴원 후 추적조사결과 환자는 별 문제없이 잘 지내고 있다.

• Clinical and Experimental Pediatrics
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• 제56권4호
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• pp.186-190
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• 2013

Lung torsion is a very rare event that has been reported in only 9 cases in the pediatric literature but has not yet been reported in Korean infants. We present a case of lung torsion after tracheoesophageal fistula repair in an infant. Bloody secretion from the endotracheal tube and chest radiographs and computed tomographic scan results indicated lung torsion. Emergency exploration indicated $180^{\circ}$ torsion of the right upper lobe (RUL) and right middle lobe (RML). After detorsion of both lobes, some improvement in the RUL color was observed, but the color change in the RML could not be determined. Although viability of the RML could not be proven, pexy was performed for both the lobes. Despite reoperation, clinical signs and symptoms did not improve. The bronchoscopy revealed a patent airway in the RUL but not in the RML. Finally, the RML was surgically removed. The patient was discharged on the 42nd day after birth.

• 대한기관식도과학회지
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• 제8권1호
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• pp.61-65
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• 2002

Background : Acquired tracheoesophageal fistula(TEF) results mostly from Prolonged tracheal intubation and insertion of nasogastric tube. Although the incidence has decreased since the usage of low pressure, high volume cuff of endotracheal tube, it is seldom cured spontaneously and needs surgical treatment. Material and Methods : We have retrospectively reviewed five cases of TEF who underwent surgical treatment for cure from March, 1990 to September, 2001 and analyzed the cause, treatment, postoperative complications and prognostic factors. Results : Majority were men(80% : 4 of 5 patients) and the mean age was 29.4 years old(range, 11-58). The most predominant etiology was prolonged intubation or tracheostomy(80% : 4 of 5 patients) and 3 of 5 patients were treated by tracheal resection and end to end anastomosis with primary closure of esophagus. Postoperative complications occurred in 4 patients the most common complications were wound infection(4 cases) and esophageal leakage(2 cases). Extubation was done on postoperative day 11.5(range, 1-33) days, and factors causing delayed extubation were status esophagus. epilepticus, edema, and tracheal stenosis. Conclusion : Spontaneous closure of TEF is seldom possible and the surgical treatment of choice is tracheal resection and end to end anastomosis with primary repair of the esophagus. preoperative pulmonary rehabilitation and early extubation postoperatively are important factors for success.

• Advances in pediatric surgery
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• 제14권1호
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• pp.1-11
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• 2008

The aim of this study is to analyze the outcomes of the esophageal atresia with tracheoesophageal fistula over the last 2 decades. The records of 51 patients born between 1987 and 2006 were reviewed. Twenty-seven patients were male. Mean values of the age, gestational age and birth weight were 2.9 days, 296 days and 2.7kg, respectively. All patients had Gross type C anomalies. Thirty-one patients (60.7 %) had one or more associated congenital anomalies and the most common anomaly was cardiac malformation. In 48 cases, primary anastomosis was done and staged operation was done in one case. Circular myotomies in the proximal esophagus were performed in 9 cases. Postoperative complication developed in 26 cases (54 %): pulmonary complication in 12 cases, anastomotic leakage in 10 and anastomotic stricture in 10, recurrent trachoesophageal fistula in one and tracheomalasia in 2 cases. Reoperation was carried out in 2 patients with anastomotic leaks, the remaining leaks were managed non operatively. Three of the strictures were reoperated upon and the others were successfully managed by balloon dilatations. Overall mortality rate was 15.6 %. Mortality rate of the second 10 years (8 %) period decreased significantly compared to that of the first 10 years (23 %) period.

• 대한기관식도과학회지
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• 제6권1호
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• pp.90-95
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• 2000

Isolated(H-type) tracheoesophageal fistula without esophageal atresia occurs in approximately 4% of esophageal anomalies, and represents the least form of abnormal laryngotracheo-esophageal communication. Its symptoms such as coughing and choking The during the feeding, abdominal distension and recurrent pneumonitis usually start from birth. Diagnosis is made between 4 days to 4 years using the contrast esophagography and/or tracheoscopy. In case of diagnostic delay the postoperative mortality is not negligible and the most common cause of mortality is respitatory problems(infection, respiratory distress). So early diagnosis is essential in the newborn period with high index of suspicion. We report a case of H-type TEF in which operative repair was successful with references to recent literature.

• Journal of Chest Surgery
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• 제27권6호
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• pp.489-493
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• 1994

Our patient was a 2.3 kg, male of 33 weeks gestation and spontaneous vaginal delivery. Copious salivary secretion, mild aspiration pneumonia episode due to tracheoesophageal fistula and intermittent cyanotic appearance due to hypoxia were noted shortly after birth. Head up position, frequent upper pouch suction, and adequate fluid and antibiotic therapy were done in incubator. Combined Chest and abdominal film was revealed gas in the stomach and an haziness in right chest with mediastinal shift to the right side. Esophagogram revealed markedly dilated proximal esophagus as blind pouch, and Two dimensional echocardiography showed the Ventricular Septal Defect. The conclusion was congenital esophageal atresia with tracheoesophageal fistula, Vogt-Gross type C, Waterston Risk Category B. Surgical correction with Beardmore anastomosis was performed extrapleurally through 3rd rib bed after the cannulation of umbilical vein and preliminary gastrostomy. The fistula was closed by triple ligation and the upper pouch was then brought down to the presenting surface of the lower esophageal segment that incised, and end to side anastomosis was underwent using interrupt suture placed through the full thickness of both upper pouch and lower esophageal segment. The postoperative patient was well tolerated and recovered uneventfully, permitted feeding on 7th postoperative day after esophagogram.

• Journal of Chest Surgery
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• 제54권3호
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• pp.206-213
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• 2021

Background: Tracheoesophageal fistula (TEFs) is a rare condition that requires complex surgical treatment. We analyzed the surgical outcomes of TEF reported in the literature and at Pusan National University Yangsan Hospital using standardized techniques. Methods: This retrospective study included 8 patients diagnosed with acquired benign TEF between March 2010 and December 2019. The surgical method was determined based on the size of the fistula observed within the endoscope. Results: TEF occurred in 7 patients (87.5%) after intubation or tracheostomy and in 1 patient (12.5%) after esophageal surgery due to conduit necrosis. For tracheal management, 5 and 2 patients underwent tracheal resection and end-to-end anastomosis and primary repair, respectively. The median length of resection was 2.5 cm (range, 1.3-3.4 cm). For esophageal management, 6 patients underwent primary repair and 1 patient underwent esophageal diversion. One patient underwent TEF division with a stapler. Interposition of a muscle flap was performed in 2 patients. TEF recurrence, esophageal stenosis, and dehiscence or granulation occurred in 1, 1, and 2 patients, respectively. A long-term tracheostomy tube or T-tube was used in 2 patients for >2 months. Conclusion: Although TEF surgery is complex and challenging, good results can be achieved if surgical standards are established and experience is accumulated.