• 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.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.611-616
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• 2009

Purpose: The rate of fistulas occuring followed by resection of oral cavity, oropharyngeal, hypopharyngeal, and laryngeal cancer are reported to be 9 ~ 23% according to various documents. Neglected treatment of the fistula can result in a setback in proper treatment with restrictions in oral intake leading to delayed return to daily life. Furthurmore, in severe cases, it may injure important vessels and adjacent structures of the neck area. The author reviewed previously reported cases of treatment methods for fistulas recurring after diverse head and neck operations and with sharing the treatment experiments of our patients, we tried to present a treatment algorism for different fistula types. Methods: Our study was based on retrograde analysis of 64 patients who were clinically diagnosed with fistula after operation for cancer of the head and neck from 1997 to 2008 at Severance Hospital. Their primary sites of cancer were 8 oral cavity, 22 oropharynx, 25 hypopharynx, and 9 larynx. The patients were aged 45 to 75 years and the male to female ratio was 11 to 1. The patient's operation records and progress notes were evaluated for determination of degree of fistula and treatment methods. Results: Most fistulas were clinically suspected after postoperative 5 days and symptoms noted for detection of the fistula were erythema, purulent discharge, edema, tenderness, and fluctuation. The fistula was definitely diagnosed at postoperative 2 weeks with barium test and treatment method ranging from conservative management to operative procedure were applied to each patients. Total 21 patients were managed with conservative protocol. In 15 cases, direct repair of the fistula was done and more stable repair of the fistula was possible with using of TachoComb$^{(R)}$. Pharyngostoma was performed in 14 patients. Among them, 4 patients healed spontaneously, 5 patients were taken direct closure, 4 patients were taken pectoralis major musculocutaneous flap, and one patient was taken esophageal transfer. The other 14 patients were taken 11 pectoralis major musculocutaneous flaps and 3 free flaps without pharyngostoma formation. Conclusion: Fistula is a troublesome complication resulting after resection of head and neck cancer. Early detection and adequate treatment according to the period and condition of the fistula may prevent further complications and reduce the pain of the patient.

• Journal of Chest Surgery
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• 제26권4호
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• pp.333-336
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• 1993

Esophageal atresia and tracheoesophageal fistula may occur as separate entities but usually occur in combination.The first report of esophageal atresia with tracheoesophageal fistula was done by Thomas Gibson in 1696.In1941, Haight and Towlseg performed the first successful primary repair,recently we were experienced a case of esophageal atresia with distal tracheoesophageal fistula in infant patient who presented the symptoms of dyspnea and vomiting.The operation was performed transpleurally through right 4th intercostal space.Patient tolerated all the operative procedure and recovered uneventflly.He was well-being without other problem.

• Journal of Chest Surgery
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• 제23권5호
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• pp.968-975
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• 1990

An aortobronchial fistula is a rare complication of aneurysm of the aorta. The fistula starting from a chronic traumatic aortic aneurysm is exceptionally rare. Our observation concerns a patient of 26 with previous chest trauma who had atelectasis of left lung following dyspnea and hemoptysis. Aortography and surgical intervention revealed that this was a chronic traumatic aortic aneurysm of descending thoracic aorta, which developed a fistula in the bronchus. She underwent left posterolateral thoracotomy and the surgical repair of the aneurysm was performed with a woven Dacron patch graft using a temporary external bypass between the ascending and the descending aorta. The fistula in the bronchus was closed with simple interrupted sutures. In the immediate postoperative period, double vision, headache, and hoarseness developed but returned normal.

• Journal of Chest Surgery
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• 제41권4호
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• pp.520-522
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• 2008

원발성 대동맥-식도 누공은 드문 질환으로 식도 내로 대량의 출혈을 일으키는 치명적인 질환이다. 원인으로는 흉부 대동맥류가 가장 흔하며, 암에 의한 궤양, 염증 등이 있다. 수술이 근치적 치료 방법이지만 유병률과 사망률이 높으며, 최근에는 스텐트-그라프트를 이용한 비수술적 치료 방법이 소개되고 있다. 저자들은 수술을 통해 누공을 박리하고 식도와 대동맥을 일차 봉합하여 치료한 원발성 대동맥-식도 누공 1예를 문헌 고찰과 함께 보고한다.

• Archives of Plastic Surgery
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• 제46권3호
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• pp.277-281
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• 2019

Recto-vaginal fistulas are difficult to treat due to their high recurrence rate. Currently, no single surgical intervention is universally regarded as the best treatment option for recto-vaginal fistulas. We present a case of recurrent recto-vaginal fistula surgically treated with a gracilis pull-through flap. The surgical goals in this patient were complete excision of the recto-vaginal fistula and introduction of fresh, vascularized muscle to seal the fistula. A defunctioning colostomy was performed 1 month prior to the present procedure. The gracilis muscle and tendon were mobilized, pulled through the freshened recto-vaginal fistula, passed through the anus, and anchored externally. Excess muscle and tendon were trimmed 1 week after the procedure. Follow-up at 4 weeks demonstrated complete mucosal coverage over an intact gracilis muscle, and no leakage. At 8 weeks post-procedure, the patient resumed sexual intercourse with no dyspareunia. At 6 months post-procedure, her stoma was closed. The patient reported transient fecal staining of her vagina after stoma reversal, which resolved with conservative treatment. The fistula had not recurred at 20 months post-procedure. The gracilis pull-through flap is a reliable technique for a scarred vagina with an attenuated recto-vaginal septum. It can function as a well-vascularized tissue plug to promote healing.

• Archives of Plastic Surgery
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• 제36권3호
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• pp.333-335
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• 2009

Congenital palatal fistulas are rare, and few cases have been reported. Most reported cases present with a submucous cleft palate. In terms of etiology, whether the fistula is congenital or acquired has been debated. Moreover, there is not a generally accepted surgical procedure for repair of palatal fistulas. We present a case of a congenital palatal fistula with a submucous cleft palate that was successfully treated with a Furlow double - opposing Z - plasty. We discuss palatal fistulas with a review of the literature.

• Journal of Chest Surgery
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• 제45권6호
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• pp.421-423
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• 2012

Transradial access is a widely accepted method for percutaneous coronary diagnostic and interventional procedures, and it has dramatically reduced access site vascular complications compared to transfemoral access. Arteriovenous fistula formation at the access site is an especially rare complication in transradial access. We report an extremely rare case of delayed radial arteriovenous fistula that developed one year after transradial coronary angiography, which was successfully treated by surgical repair.

• 대한기관식도과학회지
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• 제8권1호
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• pp.57-60
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• 2002

Tracheoinnominate artery fistula is a rare but a catastrophic complication after tracheostomy or tracheal reconstruction. We experienced two cases of tracheoinnominate artery fistula after tracheal reconstruction and tracheostomy. The first patient was a 11 year old girl with cerebral arteriovenous malformation who maintained tracheostomy for 6 months before undergoing tracheal reconstruction. Three days after tracheal reconstruction, massive bleeding occurred through the intubation tube. She underwent emergency reoperation of repair the innominate artery with 5-0 Prolene and reconstruction of trachea. She died of bleeding 3 days after the reoperation. The second patient was a 68 year old man who underwent right upper lobectomy due to lung cancer. After operarion MRSA Pneumonia was developed and tracheostomy was performed 10 days after intubation. Twelve days after tracheostomy, massive bleeding occurred and emergency operation of ligation of innominate artery was performed. He died of sepsis 7 days after reoperation.

• Journal of Chest Surgery
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• 제27권5호
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• pp.399-401
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• 1994

We experienced one case of surgical treatment of A-V fistula between the right common iliac artery and the right common iliac vein after lumbar laminectomy. The average vascular surgeon does not have extensive experience with this disorder owing to its rarity. Arteriovenous fistula of the aorta and its major branches present an unparalleled challenge in patient care. Because of their central location, blood flow through these fistulas may be massive;the associated complications are usually dramatic, resulting in severe refractory congestive heart failure, massive venous hypertension, or extensive hemorrhage during an illfated surgical repair.For this reason, it behooves one to become well acquainted with the problem in order to avoid morbid complications and thus ensure optimal patient care.