• Advances in pediatric surgery
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• 제9권2호
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• pp.140-142
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• 2003

• Advances in pediatric surgery
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• 제11권2호
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• pp.165-170
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• 2005

The repair of esophageal atresia with a long gap continues to pose difficulties for the surgeon. There is a general agreement that the child's own esophagus is the best, however, primary repair is not always possible. Foker JE et al. (1997) developed a technique of esophageal lengthening using external traction sutures. We successfully treated one patient with a 4.5cm gap esophageal atresia (4 vertebral spaces) using the external traction suture technique.

• Advances in pediatric surgery
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• 제3권2호
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• pp.152-159
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• 1997

Transhiatal gastric transposition was performed in two case of long gap esophageal atresia without tracheoesophageal fistula. The patients were a 12 months old female and an 18 months old male. Stamm type gastrostomies were performed at other hospitals in both cases. The stomach was mobilized preserving the right gastric artery, the right gastroepiploic artery and spleen. A portion of the proximal and the distal esophageal segment were excised by transcervical and transhiatal route, respectively. The mobilized stomach was pulled up to the neck through the esophageal hiatus and posterior mediastinum. The esophagogastrostomy, the only one anastomosis of this procedure, was performed in the neck. There was no clinical evidence of anastomotic leakage, stricture, regurgitation, difficulty of gastric emptying, hoarseness or respiratory problem. Transhiatal gastric transposition seems to be a safe and easy alternative surgical procedure for esophageal replacement in long gap esophageal atresia.

• Advances in pediatric surgery
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• 제1권2호
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• pp.162-169
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• 1995

Since 1988, we have performed esophageal replacement with the reversed gastric tube on four esophageal atresia patients. Three patients had long-gap esophageal atresias and one patient had recurrent tracheoesophageal fistula that was previously operated on three times. One combined imperforate anus. The youngest patient was 6-month-old and the oldest, 34-month-old at the time of procedure. The technique of gastric tube construction is described. There have been both major and minor complications. Although two patients had shown distal tube strictures as late complications. those were solved with tuboplasties on 29 months and 48 months, postoperatively. Growth and development have been acceptable in all four patients, although most remain in the lower percentiles for growth and height, a condition that usually predates the esophageal substitution. Conclusively, reversed gastric tube interposition has proved very satisfactory for long-gap esophageal atresia that cannot be anastomosed primarily even by spiral myotomy and esophageal atresia with recurrent tracheoesophageal fistula having destroyed esophagus due to previous operation.

• Advances in pediatric surgery
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• 제10권2호
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• pp.92-98
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• 2004

The history of esophageal replacement in infants or children is the history of development of various kinds of alternative conduits such as stomach, colon, and small bowel. The gastric tube has been the most widely used conduit. From January 1988 to May 2003, 23 esophageal replacements with gastric tube were performed at the Department of Pediatric Surgery, Seoul National University Childrens Hospital. Statistical analysis was performed using Windows SPSS11.0 Pearson exact test. There were Gross type A(n=10), type B(n=1), type C(n=11), type D(n=1). Ten patients who had long gap esophageal atresia (type A-8, type B-1, type C-1) and 13 patients (type A 2, type C-10, type D-1) who had stenosis, leakage, recurred tracheoesophageal fistula, and esophagocutaneous fistula after previous corrective operations, had esophageal replacement with gastric tube. Mean follow-up periods were 4 year 2 months (7 months-15 year 1 month). There were postoperative complications including GERD in 16 (69.6 %), leakages in 7 (30.4 %), diverticulum at anastomosis in 2 (8.7 %), anastomosis site stenosis in 4 (17.3 %), and distal stenosis of the gastric tube in 1 (4.3 %). There was no statistical significance between operation types and postoperative leakage and gastroesophageal reflux. In conclusion, esophageal replacement with gastric tube may be a useful surgical option in esophageal atresia with long gap and esophageal atresia complicated by previous corrective operation.

• Journal of Chest Surgery
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• 제30권2호
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• pp.236-240
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• 1997

긴 간격(longgap)의 A형 식도 폐쇄증을 가진 신생아의 치료는 복잡하고 아직까지 이견이 많아, 본래의 식도나 위, 소장, 대장 등을 이용한 치환술로 다양한 식도 재건술이 시행되고 있다. 저자는 long gap의 A형 식도 폐쇄증을 가진 재태기간 28주, 체중 1.2kg의 미숙아에서 식도 단단문합술을 시행하여 좋은 결과를 얻었기에 문헌고찰과 함께 보고하는 바이다. 1차 처치로 위루술를 하고 2차로 식도 단단문합을 시행하였다. 술후 제한된 문함부유출과 종격동염이 발생하였으나 흉관을 통한 적절한 배액(drainage)과 동시에 위루술을 통하여 문합부유출부위에 음압 (negative pressure)을 걸어 지속적 인 흘인(suction)으로 치료하여 호전되었다. 환아는 건강하게 퇴원하였으며 술후 4개월이 지난후 5.4kg으로 체중의 증가가 있었다.

• Journal of Chest Surgery
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• 제32권6호
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• pp.567-572
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• 1999

배경: 선천성 식도 폐쇄증의 수술적 교정은 많은 개선을 보였으나 아직도 사망률과 합병증률이 높은 상태이다. 방법: 1992년 1월부터 1997년 3월까지 본 동아대학교 병원 흉부외과학 교실에서는 27명의 선천성 식도 폐쇄증을 수술적 치료하였기에 이를 후향적으로 분석하고자 하였다. 결과: 남아가 21명 여아가 6명이었으며 평균 출생시 체중은 2.62$\pm$0.38 kg이었다. 원위부 기관식도루를 가진 식도폐쇄증이 24명이었고 나머지 3명은 순수 식도 폐쇄증이었다. Waterston의 위험군 분류상 A군이 4명, B군이 18명, C군이 5명이었다. 18명에서 동반 기형을 가졌으며 심혈관계 이상이 가장 흔한 동반 기형이었다. 식도 폐쇄증의 상하 식도 맹단 간의 거리는 1 cm이내의 short gap이 9명, 1내지 2 cm의 medium gap이 8명, 2 cm이상의 long gap이 7명, 3.5 cm 이상의 ultra-long gap이 3명이었다. 수술은 순수 식도 폐쇄증의 3례에서는 단계적으로 위루술 및 경부식도조루술을 시행하였고 나머지 24례는 모두 경흉강적 도달법으로 일시적 근치 교정술을 시행하였다. 추적기간 중 27명 중5명이 사망 하였는데 수술과 관련된 사망은 2명으로 그 중 1명은 급성 신부전으로 사망하였고, 1명은 문합부 누출로 인한 농흉 발생으로 사망하였다. 3명의 후기 사망이 있었는데 1명은 순수 식도 폐쇄증으로 식도-위-대장 문합술을 시행하였으나 인슐린 의존성 당뇨병으로 술후 29개월 째 사망하였고 1명은 동 괴사성장염(necrotizing enterocolitis)으로 사망, 나머지 1명은 \ulcorner선 확장술의 합병증으로 인해 술후 220일 째 십이지장 천공으로 인한 폐혈증으로 사망하였다 사망례의 분석을 통해 사망률에 영향을 미쳤던 요인들을 살펴 보았는데 gap length가 long gap이상일 경우가 사망률에 영향을 미치는 요소로서 통계적 유의성(p value<0.05)을 보였다. 결론: 수술적교정과 관련된 합병증률은 높은 편이나 이것이 수술사망률과 직결되는 것은 아니다. 전체적인 생존율은 효과적인 동반기형의 치료와 적극적인 수술후 관리가 병행될 때 더욱 향상시킬 수 있을 것이다.

• Advances in pediatric surgery
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• 제1권1호
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• pp.53-58
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• 1995

기관식도루를 동반하지 않은 원간격결손 식도폐쇄증 1예를 미리 조성한 위루와 경구를 통하여 주기적 부지를 함으로써 식도길이를 확장하여 식도-식도단단문합술로 식도의 개통복원을 할 수 있었음을 경험하였다. 이때 상부식도맹단부로부터 이중관을 이용한 지속적인 섬프배액술이 경과에 아주 긴요하며, 수술시 식도길이의 여유를 위하여 식도근환상절개술을 한 후에는 근절개부위의 협착 발생 가능성에 항상 주의하여 술 후 조기(술 후 2-4주)에 추시함이 꼭 필요하다고 생각하였다. 식도부지를 할 때에는 길이 뿐만 아니라 직경확장(특히 하부식도에서)에도 관심을 갖이면 더욱 좋은 결과를 얻을 수 있다고 판단된다.

• Advances in pediatric surgery
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• 제7권1호
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• pp.1-6
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• 2001

The aims of this study were to evaluate the prognostic predictabilities of the risk classifications (Waterston, Montreal, and Spitz), preoperative treatment of pneumonia and the length of esophageal gap in esophageal atresia. Twenty-five cases of esophageal atresia were reviewed retrospectively. The data was analyzed with Likelihood ratio test for trend and Fisher's exact test. Survival rates were 100.0 % in group A and B, and 60.0 % in group C according to Waters ton classification (p=0.027). By Montreal classification, 95.7 % in group I and 50.0 % in group II (p=0.086). By Spitz classification, 95.5 % in group I and 66.7% in group II (p=0.159). The survival rate was 85.7 % in the patients with pneumonia preoperatively treated and 94.4% in the patients without pneumonia. The difference was not significant (p=0.490). Survival rate in the patients with long gap (${\geq}$3cm) was 50.0 % and 100.0 % in patients with short gap (<3cm) with significant difference (p=0.020). The Waterston classification could be modified into two groups because the prognosis of both group A and B were the same. Preoperative pneumonia does not seem to be a risk factor. The length of the esophageal gap showed prognostic value.

• Neonatal Medicine
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• 제25권4호
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• pp.186-190
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• 2018

Esophageal atresia (EA) with proximal tracheoesophageal fistula (TEF; gross type B) is a rare defect. Although most patients have long-gap EA, there are still no established surgical guidelines. A premature male infant with symmetric intrauterine growth retardation (birth weight, 1,616 g) was born at 35 weeks and 5 days of gestation. The initial diagnosis was pure EA (gross type A) based on failure to pass an orogastric tube and the absence of stomach gas. A "feed and grow" approach was implemented, with gastrostomy performed on postnatal day 2. A fistula was detected during bronchoscopy for recurrent pneumonia; thus, we confirmed type B EA and performed TEF excision and cervical end esophagostomy. As the infant's stomach volume was insufficient for bolus feeding after reaching a body weight of 2.5 kg, continuous tube feeding was provided through a gastrojejunal tube. On the basis of these findings, esophageal reconstruction with gastric pull-up was performed on postnatal day 141 (infant weight, 4.7 kg), and he was discharged 21 days postoperatively. At 12 months after birth, there was no catch-up growth; however, he is currently receiving a baby food diet without any complications. In patients with EA, bronchoscopy is useful for confirming TEF, whereas for those with long-gap EA with a small stomach volume, esophageal reconstruction with gastric pull-up after continuous feeding through a gastrojejunal tube is worth considering.