• Annals of Surgical Treatment and Research
• /
• v.95 no.6
• /
• pp.312-318
• /
• 2018

Purpose: Acute normovolemic hemodilution (ANH) is an autologous transfusion method, using blood collected during surgery, to reduce the need for allogeneic blood transfusion. ANH is controversial because it may lead to various complications. Among the possible complications, anastomotic leakage is one that would have a significant effect on the operation outcome. However, the relationship between ANH and anastomotic site healing requires additional research. Therefore, we conducted this prospective study of ANH, comparing it with standard intraoperative management, undergoing gastric anastomosis in rats. Methods: Sixteen Sprague-Dawley rats were randomly assigned to three groups: group A, surgery with ANH; group N, surgery with standard intraoperative management; and group C, sham surgery with standard intraoperative management. ANH was performed in group A animals by, removing 5.8-6.6 mL of blood and replacing it with 3 times as much crystalloid. All rats were enthanized on postoperative day 6, and histopathologic analyses were performed. Results: The mean hematocrit values, after hemodilution were 22.0% (range, 18.0%-29.0%), group A; 33.0% (29.0%-35.0%), group N; and 32.5% (29.0%-34.0%), group C. There were significant differences between groups A and N (P = 0.019, P = 0.009, P = 0.004, P = 0.039, and P = 0.027), and between groups N and C (P = 0.006, P = 0.027, P = 0.04, P = 0.008, and P = 0.009) with respect to inflammatory cell numbers, neovascularization, fibroblast numbers, edema and necrosis, respectively; there were no differences between groups A and N. Conclusion: In rat model, anastomotic complications did not increase in the ANH group, compared with the standard intraoperative management group.

• Journal of Chest Surgery
• /
• v.57 no.2
• /
• pp.152-159
• /
• 2024

Background: Anastomotic leakage (AL) following esophagectomy represents a serious complication that often results in prolonged hospitalization and necessitates repeated interventions, including nothing-by-mouth (NPO) restriction, endoscopic vacuum therapy (EVT), or surgical repair. In this study, we evaluated the patterns and outcomes of AL treatment. Methods: We retrospectively reviewed the medical records of patients who underwent esophagectomy for esophageal cancer at a single center between 2003 and 2020. Of 3,096 examined cases, 181 patients (5.8%) with AL were included in the study: 114 patients (63%) with cervical anastomosis (CA) and 67 (37%) with intrathoracic anastomosis (TA). Results: The incidence of AL was 11.9% in the CA and 3.2% in the TA group (p<0.001). Among patients with CA who developed AL, 87 (76.3%) were managed with NPO, 15 (13.2%) with EVT, and 12 (10.5%) with surgical repair. Over 90% of patients with cervical AL resumed an oral diet by the time of discharge, regardless of treatment method. Among patients with TA and AL, 36 (53.7%) received NPO, 25 (37.7%) underwent EVT, and 6 (9%) required surgery. Of these, 34 patients who were managed with NPO and 19 with EVT could resume an oral diet. However, only 2 patients who underwent surgery resumed an oral diet, and 2 patients required additional EVT. Conclusion: Although patients with CA displayed a higher incidence of AL, their rate of successful oral intake exceeded that of those with TA, regardless of treatment method. Among patients exhibiting AL with TA, EVT was more commonly employed than in CA cases, and it appears effective.

• Journal of Chest Surgery
• /
• v.23 no.4
• /
• pp.707-714
• /
• 1990

Despite of mortality and morbidity rates that are higher than other forms of therapy, surgical resection has been mainstay for the treatment of esophageal cancer because of a prompt completeness as well as a high possibility of cure. But a substantial numbers of patients are unsuitable for surgical treatment and those undergoing resection have still poor long term survival rate. With hopes of improving long term survival, we have attempted multimodal approach, composed of preoperative induction chemotherapy utilizing Cisplatin and 5 \ulcornerFU, surgery and postoperative loco-regional radiotherapy for the treatment of esophageal cancer since 1985. During the period of 1967 \ulcorner1985, 27 patients[group A] were treated by surgery only and during recent 5 years 28 patients[group B] by multimodal treatment, Clinical review and comparison between the two groups were as follows: l. Applied surgical procedures were hand-sewn esophagogastrostomy, esophagocologastrostomy and esophagojejunostomy in group A. In group B, only esophagogastrostomy was underwent using stapler mainly. 2. Incidence of peri and postoperative complication showed no remarkable differences between the two groups, but the occurrences of leakage from the anastomotic site were 5[19% ] out of group A and 1[4%] out of group B. 3. The response rate to induction chemotherapy was 36% in group B, 4. The number of local cancer recurrence at the site of anastomosis was 6[22%] out of group A, whereas 2[7%] out of group B. 5. Postoperative I year and 2 year survival were 61%, 15% in group A and 75%, 42% in group B.

• Journal of Korean Neurosurgical Society
• /
• v.62 no.2
• /
• pp.136-143
• /
• 2019

Moyamoya disease (MMD) is a progressive cerebrovascular disease with unknown etiology, characterized by bilateral steno-occlusive changes at the terminal portion of the internal carotid artery and an abnormal vascular network formation at the base of the brain. MMD has an intrinsic nature to convert the vascular supply for the brain from internal carotid (IC) system to the external carotid (EC) system, as indicated by Suzuki's angiographic staging. Insufficiency of this 'IC-EC conversion system' could result not only in cerebral ischemia, but also in intracranial hemorrhage from inadequate collateral anastomosis, both of which represent the clinical manifestation of MMD. Surgical revascularization prevents cerebral ischemic attack by improving cerebral blood flow, and recent evidence further suggests that extracranial-intracranial bypass could powerfully reduce the risk of re-bleeding in MMD patients with posterior hemorrhage, who were known to have extremely high re-bleeding risk. Although the exact mechanism underlying the hemorrhagic presentation in MMD is undetermined, most recent angiographic analysis revealed the characteristic angio-architecture related to high re-bleeding risk, such as the extension and dilatation of choroidal collaterals and posterior cerebral artery involvement. We sought to update the current management strategy for hemorrhagic MMD, including the outcome of surgical revascularization for hemorrhagic MMD in our institute. Further investigations will clarify the optimal surgical strategy to prevent hemorrhagic manifestation in patients with MMD.

• Journal of Chest Surgery
• /
• v.18 no.1
• /
• pp.36-45
• /
• 1985

During the twelve-year period from March 1973 through July 1984, 23 consecutive operations for coarctation of the aorta were performed at Seoul National University Hospital. The patients included 19 male and 4 female in the range of 4 months and 16 years old. Associated cardiac anomalies were present in 19 patients [70%] and they were VSD+PDA [9 patients], VSD[2], PDA[1], VSD+ASD+PDA[1], VSD+MS+AS+PDA[1], D-TGA+VSD+PDA[1], P-ECD[1], MS[1], Al[1], and DORV+PDA[1]. The preoperative main symptoms included congestive heat failure, hypertension, subacute bacterial endocarditis and nonspecific symptoms. Congestive heart failure was the most common symptom in the group younger than 2 years and hypertension in the adult group. Operative techniques for coarctation of the aorta were resection and end to end anastomosis in 10 patients, prosthetic patch aortoplasty in 8, subclavian flap aortoplasty in 4, and LSCA-aortic anastomosis in 1. There were 4 operative deaths among the nine patients less than 2 years old[44.4% mortality]: all of these patients had associated cardiac anomalies. And only one operative death occurred in patients older then 2 years old[7.1% mortality]. No hospital death occurred in patients with isolated coarctation of the aorta. Operation of the coarctation was performed primarily in 6 patients associated with ventricular septal defect and subsequently underwent successful VSD closure except one operative death.

• Journal of Chest Surgery
• /
• v.18 no.3
• /
• pp.497-505
• /
• 1985

Bronchoplastic techniques represent the ideal surgical therapy for benign endobronchial tumors as well as tumors of low-grade malignant potential, such as bronchial adenomas, and for repair of traumatic airway injuries and benign strictures. This approach is also applicable to a select group of patients with carcinoma of the lung, with long-term survival being comparable to that achieved by standard pneumonectomy. Five bronchoplastic procedures were performed at Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital during 7 months periods from Dec. 1984 to Jun. 1985. Of the 5 patients, 3 patients were male and 2 patients were female and ages ranged from 8 years to 55 years old. The final diagnoses of 5 patients were as followed; traumatic bronchostenosis, endobronchial tuberculoma, carcinoid tumor, tuberculous bronchostenosis and traumatic bronchial fracture. Operative procedures of 5 patients were as followed; resection and end-to-end anastomosis of right main bronchus, left lower lobectomy and wedge resection of bronchus, left upper sleeve lobectomy, right middle and lower sleeve lobectomy and resection and end-to-end anastomosis of left main bronchus. And 2 lungs and 3 lobes could be preserved by these bronchoplastic procedures. There was no post-operative complication or mortality and all patients are being followed up without specific problem.

• Journal of Chest Surgery
• /
• v.20 no.1
• /
• pp.22-29
• /
• 1987

From Sep. 1978 to Aug. 1986, 44 cases of Fontan operation were performed at Seoul National University Hospital. 1] The diagnoses were TA in 13 [38.6%], UVH in 21 [47.79`], DORV in 3 [6.8%], TGA in 2 [4.5%] and C-ECD with DORY in 1[2.3%]. 2] There were 20 operative deaths [44.5%]. 3] The operative risk factors were early date of operation between 1978 and 1983, young age below 3 years old, direct atriopulmonary anastomosis without roofing, and postoperative high CVP above 25cmH,O. But the relation between operative mortality and various cardiac diseases was absent. 4] survived patients were followed from 1 to 54 months except 3 patients who were lost to follow up. 16 patients were in functional class I and 1 in class II, 2 of the above 17 patients were reoperated due to residual right to left shunt. In remained 4 patients, 3 patients persisted cyanosis after operation and 1 patients died 1 month postoperatively due to pulmonary embolism. 5] As 4 result, the Fontan procedure can be done with a good result for tricuspid atresia and other complex lesions. The operative mortality can be reduced further with a correct anatomical diagnosis preoperatively, rigid operative criteria to pulmonary vascular resistance, direct atriopulmonary anastomosis with roofing, and use of `Venous Assist Device` postoperatively in low cardiac output patients.

• Journal of Chest Surgery
• /
• v.26 no.8
• /
• pp.604-608
• /
• 1993

Coarctation of aorta is rather common congenital cardiovascular disease in the western contries, but it is known to be less than 2 % in Korea. From June 1986 to December 1992, seven patients of surgically treated coarctation of aorta who were less than 2 years old, were experienced at Department of Thoracic and Cardiovascular Surgery, Yeungnam University Hospital. The patients included six male and one female, with ages in the range of one month and 24 months. Four patients were preductal type and three juxtaductal. Associated cardiac anomalies were present in all patients and they were PDA[6 cases], ASD[3], VSD[2], bicuspid aortic valve[2], aortic stenosis[1], mitral regurgitation[1], and tricuspid regurgitation[1]. The operative procedures were four end to end anastomosis and three subclavian flap aortoplasty. Mean aortic cross clamping times were 37.3 minutes in patients with end to end anastomosis and 30.3 minutes in patients with subclavian flap aortoplasty. There were two operative deaths in patients who were treated with subclavian flap aortoplasty and pulmonary artery banding. One patient who had been treated with subclavian flap aortoplasty was complicated with postoperative mild paraplegia in lower limb. Pulmonary artery banding has been disappointing in our patients, and the data was suggestive that earlier total repair of complicated coarctation might improve survival.

• Journal of Chest Surgery
• /
• v.33 no.6
• /
• pp.487-493
• /
• 2000

Background: Early patency of the coronary artery bypass grafting is determined mainly by surgical technique and status of coronary artery. We analyzed the early result, focusing on the relationship between postoperative angiographic findings and the patency rate. Material and method: During the period of July 1997- August 1999, 86 cases of CABG were performed and the postoperative coronary artery angiography was done in 76 cases on postoperative day 7 to assess the graft patency. Result: Overall graft patency was 90.2% on the angiographic finding. Factors influencing the early graft occlusion were the surgeon's experience, small coronary artery size less than 1.5mm in diameter, coronary arteries related to pre-operative myocardial infarction, and local atheroma at the anastomosis site(p<0.001). Operative mortailty was 2.3%. Early recurrence of the symptom was 19.8% during the follow up period. Conclusion: We examined the postoperative coronary angiography and found that the surgeon's experience, small coronary artery size less than 1.5mm in diameter, bypass surgery on the coronary arteries related to pre-operative myocardial infarction, and local atheroma at the anastomosis site were the factors for the graft occlusion.

• Journal of Korean Neurosurgical Society
• /
• v.50 no.1
• /
• pp.23-29
• /
• 2011

Objective : The aim of the study is to determine the efficacy of indocyanine green (ICG) videoangiography for confirmation of vascular anastomosis patency in both extracranial-intracranial and intracranial-intracranial bypasses. Methods : Intraoperative ICG videoangiography was used as a surgical adjunct for 56 bypasses in 47 patients to assay the patency of intracranial vascular anastomosis. These patients underwent a bypass for cerebral ischemia in 31 instances and as an adjunct to intracranial aneurysm surgery in 25. After completion of the bypass, ICG was administered to assess the patency of the graft. The findings on ICG videoangiography were then compared to intraoperative and/or postoperative imaging. Results : ICG provided an excellent visualization of all cerebral arteries and grafts at the time of surgery. Four grafts were determined to be suboptimal and were revised at the time of surgery. Findings on ICG videoangiography correlated with intraoperative and/or postoperative imaging. Conclusion : ICG videoangiography is rapid, effective, and reliable in determining the intraoperative patency of bypass grafts. It provides intraoperative information allowing revision to reduce the incidence of technical errors that may lead to early graft thrombosis.