• Advances in pediatric surgery
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• 제14권1호
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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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• 제25권3호
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• pp.211-217
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• 2022

Purpose: Outcomes between primary gastrostomy tubes and buttons (G-tube and G-button) have not been established in pediatric patients. We hypothesized that primary G-tube have decreased complications when compared to G-button. Methods: A retrospective review of surgically placed gastrostomy devices from 2010 to 2017 was performed. Data collected included demographics, outcomes and 90-day complications. We divided the patients into primary G-tube and primary G-button. Results: Of 265 patients, 142 (53.6%) were male. Median age and weight at the time of surgery were 7 months (interquartile range [IQR], 2-44 months) and 6.70 kg (IQR, 3.98-14.15 kg), respectively. Among the groups, G-tube had 80 patients (30.2%) while G-button 185 patients (69.8%). There were 153 patients with at least one overall complication within 90 days postoperative. There was no significant difference in overall complications between groups (G-tube 63.8% vs. G-button 55.7%, p=0.192). More importantly, there were no significant differences in major complications among the groups, G-tube vs. G-button (5% vs. 4%; p=0.455). Conclusion: Primary G-tube offers no significant advantage in overall, minor or major complications when compared to primary G-button.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제7권1호
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• pp.8-15
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• 2004

목 적: 내시경적 위루술은 수술적 위루술에 비해 안전하고 합병증 발생이 적은 만성 영양 결핍 환아의 경장 영양법으로 소아에서 이에 대한 비교분석이 드물어 위루술 후 발생하는 합병증에 대해 알아보고자 하였다. 방 법: 1994년부터 2002년까지 위루술을 시행받은 66례의 의무기록정보를 후향적으로 분석하였다. 결 과: 내시경적 위루술 23례(평균연령 49개월, 추적관찰 13개월), 수술적 위루술 43례(평균연령 29개월, 추적관찰 21개월)이었다. 수술군 중 31례는 위저 추벽 성형술과 동시에 위루술을 시행 받았다. 주요 합병증은 수술군의 55%, 내시경군의 33%에서 발생하였다. 주요 합병증 발생은 내시경군($0.39{\pm}0.58$)이 수술군($0.81{\pm}0.85$)에 비해 유의하게 낮았다(p<0.05). 부 합병증의 발생도 내시경군($1.68{\pm}1.75$)이 수술군($2.7{\pm}2.07$)에 비해 유의하게 낮았다(p<0.05). 주요 합병증 중 흡인성 폐염이 가장 많았으나 내시경군이 수술군에 비해 유의하게 낮게 발생한 것은 마비성 장폐색이었다. 위 식도 역류로 위저 추벽 성형술을 시행한 수술적 위루술군 25% (8/31)에서 위식도 역류가 재발하였고 17% (2/12)에서 새로이 발생하였다. 내시경군은 위루술 전 17% (4/23)에서 위식도 역류가 있었으며 5% (1/19)가 새로이 발생하였고 그 중 2례에서 위저 추벽 성형술을 시행 받았다. 전체 66례 중 8례의 환아가 사망하였으나 위루술과 연관은 없었다. 경구식이가 가능하여 위루관을 제거한 경우는 내시경군 5례, 수술군 3례이었다. 결 론: 위루술은 합병증 발생이 적지 않았으나 내시경적 위루술이 수술적 위루술에 비해 합병증 발생이 유의 하게 낮아 일차적으로 선택될 수 있는 위루술임을 확인하였다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제17권4호
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• pp.214-222
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• 2014

Purpose: The method of percutaneous endoscopic gastrostomy (PEG) tube placement can be divided into the pull and introducer techniques. We compared short-term complications and prognosis between patients who underwent the pull technique and two other types of introducer techniques, the trocar introducer technique and T-fastener gastropexy technique. Methods: Twenty-six patients who underwent PEG were enrolled in this study. We retrospectively investigated the age, sex, body weight, weight-for-age Z-score, underlying diseases, PEG indications, complications, duration of NPO (nil per os), pain control frequency, and duration of antibiotic therapy. The patients were classified into three groups according to the PEG technique. The occurrence of complications was monitored for 10 weeks after the procedure. Results: The age, sex, body weight, and weight-for-age Z-score were not significantly between the three groups. Most patients had cerebral palsy and seizure disorders. Dysphagia was the most common indication for PEG. Major complications occurred in 5 (50%), 4 (66.7%), and 0 (0%) patients in group I, II, and III, respectively (p=0.005). Further, peristomal infection requiring systemic antibiotic therapy occurred in 2 (20%), 3 (50%), and 0 (0%) patients in group I, II, and III, respectively (p=0.04). There was no significant difference between the groups with respect to minor complications, duration of NPO, pain control frequency, and duration of antibiotic therapy. Conclusion: The results indicate that the T-fastener gastropexy technique was associated with the lowest rate of major complications.

• Advances in pediatric surgery
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• 제6권2호
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• pp.100-105
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• 2000

Eleven children with gastroesophageal reflux disease underwent fundoplication. Eight had neurological impairment, two had hiatal hernias and one had a history of esophageal repair for esophageal atresia. The most common and significant symptom was vomiting(81.8 %), followed by recurrent respiratory infections(72.7 %) and failure to thrive(72.7 %). The most common diagnostic tool was 24 hour esophageal pH study, which showed pH less than 4 for more than 10 % of the total recorded time in 6 of 9 patients. Nissen fundoplication was performed in 10 patients. Thal fundoplication was carried out in one patient with esophageal atresia. Stamm gastrostomy was added for nutritional and/or swallowing problem in all 8 patients with neurological impairment. The median follow up period was 13 months. There was one late death of unrelated cause and one recurrence. The quality of life after antireflux surgery was greatly improved. Antireflux surgery should be done if indicated, and a simultaneous gastrostomy considered in a patient with neurological impairment.

• 대한영상의학회지
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• 제81권5호
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• pp.1175-1183
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• 2020

목적 수술이 불가능한 악성 위십이지장 협착 환자에서 구강 경유 스텐트 설치술 실패 시 경피적 위 경유 스텐트 설치술의 기술적 타당성과 임상적 효용성에 대해 알아보았다. 대상과 방법 이 연구는 2008년 10월부터 2016년 4월까지 악성 위십이지장 협착이 있는 환자 중, 구강 경유 스텐트 설치술이 어렵거나 실패하여 위 경유 스텐트 설치술을 시행한 9명의 환자를 대상으로 하였다. 환자는 췌장암 5명, 위암 2명, 전이암 2명이었다. 경피적 위루술(percutaneous gastrostomy) 후, 이 경로를 통해 이중 팽창성 스텐트를 협착 부위에 설치하였다. 기술적, 임상적 성공률과 합병증에 대해 조사하였다. 결과 기술적 성공률은 8명의 환자에서 성공적으로 설치되어 88%였다. 1명의 환자에서는 협착 부위로 유도 철사가 통과되지 않아 실패하였다. 스텐트 설치 후, 7명의 환자에서 증상의 호전을 보여 임상적 성공률은 87.5%였다. 위루관은 9~20일 후(평균 12일) 제거되었다. 시술과 관련된 주요 합병증은 발생하지 않았다. 평균 추적관찰 기간은 136일(범위, 3~387일)이었고, 1명의 환자에서 스텐트 원위부에 종양의 과성장에 의한 재협착이 발생하였다. 결론 수술이 불가능한 악성 위십이지장 협착 환자에서 구강 경유 스텐트 설치술에 실패한 경우 경피적 위 경유 스텐트 설치술은 기술적으로 어렵지 않고 임상적으로 효과적인 치료 방법으로 생각된다.

• 대한음성언어의학회:학술대회논문집
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• 대한음성언어의학회 2008년도 제28차 학술대회
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• pp.36-36
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• 2008

• Journal of Chest Surgery
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• 제17권2호
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• pp.275-279
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• 1984

Between June 1, 1971 and June 31, 1983, 90 patients of esophageal carcinoma were experienced at N.M.C. Surgery was applied to 63 patients [70%]; Exploratory operations, including feeding gastrostomy, feeding jejunostomy, & esophagecutenostomy with feeding gastrostomy, was done in 26 patients due to advanced stage or general condition. Esophagogastrectomy [or esophagectomy] with esophagogastrostomy was done in 25 patients, curative operation in 9 patients & palliative operation in 16 patients. Colon bypass in 12 patients, 7 cases with tumor resection & 5 cases without resection. Postoperative complications were anastomotic leakage [14.3%], respiratory complications [19.1%], & others. Anastomotic leakage & respiratory complications were major fatal complication in surgery of esophageal carcinoma. Postoperative mortality was mainly due to respiratory complications [14.3%] & anastomotic leakage [7.9%].

• Journal of Chest Surgery
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• 제23권2호
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• pp.396-401
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• 1990

This report is an review of 5 cases of congenital esophageal atresia associated with tracheoesophageal fistula which were treated in the Department of Thoracic and Cardiovascular Surgery, Chonnam University Hospital from January, 1987 to February, 1989. First patient that was associated with VATER’s syndrome and moderate pneumonia, i.e., Waterston Category C was treated by gastrostomy, colostomy and primary anastomosis, but expired. Second patient that was weighed 2.2 Kg, suffered from moderate pneumonia was treated by gastrostomy, but died from asphyxia. The other patients were treated by primary repair. Any anastomotic leakage or gastroesophageal reflux was not found in these cases, but mild anastomotic strictures were found in these patients by postoperative esophagography. However, esophageal dilatation of anastomotic strictures was successful using the Griintzig balloon catheter.

• Journal of Chest Surgery
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• 제6권1호
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• pp.95-100
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• 1973

This is a report on a total of four cases of esophageal perforation due to fish bone in the Department of Thoracic Surgery, Hanyang University Hospital. The perforated portions of esophagus were upper third of esophagus, that is, cervical esophalgus principally. The complications after esophageal perforation were acute mediastinitis with mediastinal emphysema in 2 cases, acute mediastinitis with both pyothorax in one case and cervical subcutaneous abscess alone in one case. Collar mediastinostomy was required to control disturbance of cardiopulmonary function as emergency procedure. Gastrostomy was of worthy for the various purposes, that` is, for feeding, absolute rest of the esophagus, and for prevention against continuous infection from esophageal leakage. After the gastrostomy. 3 cases were healed by spontaneous closure of esophageal perforation between one to four weeks. One case expired from severe septic shock due to acute diffuse mediastinitis and both pyothorax.