• Journal of Chest Surgery
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• v.43 no.3
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• pp.340-343
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• 2010

Gastropleural fistula is a rare complication of prior lung surgery, gastric ulcer, trauma and malignancy. A 62 year old female patient who had received surgical repair of a perforated gastric wall 10 years prior, underwent open pleural decortication. At 4 days after surgery, food residuums were noticed at the chest bottles. Hence, an emergency esophagogram was done. The esophagogram revealed a gastropleural fistula. The patient received a total gastrectomy, intra-abdominal diaphragmatic repair and massive thoracic saline irrigation through a previous thoracic wound. The patient was discharged 11 days after surgery without other morbidity.

• Journal of Chest Surgery
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• v.32 no.3
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• pp.315-317
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• 1999

The complications associated with the use of pulmonary artery catheter include dysrhythmias, heart block, pulmonary artery rupture, pulmonary infarction, endocardial damage, balloon rupture, arterial puncture, thromboembolism, air embolism, infection, pneumothorax, and knotting of the catheter. Knotting of the catheter is a rare complication and it should be anticipated if there is an excessive advancement of the pulmonary artery catheter beyond the normally expected distance. We report a successful surgical removal of knotted pulmonary artery catheter by sternotomy and cardiopulmonary bypass.

• Journal of Korean Neurosurgical Society
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• v.64 no.6
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• pp.922-932
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• 2021

Objective : It is challenging to make solid fusion by posterior screw fixation and laminectomy with posterolateral fusion (PLF) in thoracic and thoracolumbar (TL) diseases. In this study, we report our experience and follow-up results with a new surgical technique entitled posterior thoracic cage interbody fusion (PTCIF) for thoracic and TL spine in comparison with conventional PLF. Methods : After institutional review board approval, a total of 57 patients who underwent PTCIF (n=30) and conventional PLF (n=27) for decompression and fusion in thoracic and TL spine between 2004 and 2019 were analyzed. Clinical outcomes and radiological parameters, including bone fusion, regional Cobb angle, and proximal junctional Cobb angle, were evaluated. Results : In PTCIF and conventional PLF, the mean age was 61.2 and 58.2 years (p=0.46), and the numbers of levels fused were 2.8 and 3.1 (p=0.46), respectively. Every patient showed functional improvement except one case of PTCIF. Postoperative hematoma as a perioperative complication occurred in one and three cases, respectively. The mean difference in the regional Cobb angle immediately after surgery compared with that of the last follow-up was 1.4° in PTCIF and 7.6° in conventional PLF (p=0.003), respectively. The mean durations of postoperative follow-up were 35.6 months in PTCIF and 37.3 months in conventional PLF (p=0.86). Conclusion : PTCIF is an effective fusion method in decompression and fixation surgery with good clinical outcomes for various spinal diseases in the thoracic and TL spine. It provides more stable bone fusion than conventional PLF by anterior column support.

• Journal of Chest Surgery
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• v.55 no.1
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• pp.37-43
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• 2022

Background: The surgical strategy for single-stage resection of primary colorectal cancer (CRC) and synchronous pulmonary metastases remains a matter of debate. Methods: Perioperative data of patients who underwent single-stage resection of primary CRC and synchronous pulmonary metastases were compared to those of patients who underwent 2-stage resections. The demographic data, number of metastases, type of pulmonary and colorectal resections, operation time, blood loss, postoperative complications, morbidities, mortality, medical costs, and length of hospital stay were analyzed. Results: Twenty-two patients underwent single-stage resection of primary CRC and pulmonary metastases, while 27 patients underwent 2-stage resection. Tumor size and the number of pulmonary metastases were not significantly different between the 2 groups. The extent of pulmonary metastasectomy and abdominal procedures were similar in both groups, as was the thoracic surgical approach (video-assisted thoracic surgery vs. thoracotomy). However, open laparotomy was performed more frequently in the 2-stage group than in the single-stage group (p=0.045), which also had a longer total anesthetic time (p=0.013). The operation time, medical costs, estimated blood loss, complication rates, and severity were similar in both groups, but the length of hospital stay was shorter in the single-stage group (p<0.001). Conclusion: Single-stage colorectal and pulmonary resection shortened the overall hospital stay, with no significant changes in operation time, medical costs, hospital mortality, and morbidity. Therefore, single-stage resection could be a good surgical strategy in selected patients.

• Journal of Chest Surgery
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• v.31 no.6
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• pp.624-628
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• 1998

Postpneumonectomy syndrome is a rare and delayed complication of left pneumonectomy in most patients with normal mediastinal vascular anatomy. This syndrome is characterized by dyspnea and recurrent pulmonary infection in the remaining right lung that typically occur within the first postoperative year. The condition is believed to be secondary to postsurgical changes that include a marked shift of the mediastinum to the left, clockwise rotation of the heart and great vessels, and herniation of the right lung into the left anterior thorax. These changes lead to compression of the trachea or right main bronchus among the thoracic spine and the right pulmonary artery. We report a case of postpneumonectomy syndrome in 15 year-old girl that followed by left pneumonectomy for bronchiectasis 6 years ago. We have inserted an expandable prosthesis in the left thoracic cavity posterior to the heart. After implantation of an expandable prosthesis, an anatomic reposition of the shifted mediastinum was achieved, which resulted in instantaneous and sustained relief. The post-operative course was uneventful and the patient was followed in OPD from after discharge to now.

• Journal of Chest Surgery
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• v.19 no.4
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• pp.618-626
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• 1986

Univentricular heart is a rare congenital cardiac anomaly in which the atrial chambers are connected to only one ventricular chamber and it consists of a diverse group of cardiac malformation characterized by both AV valves or a common AV valve opening into the same ventricle, or the presence of only a solitary AV valve. In spite of recent development in cardiac surgery, corrective operations for univentricular heart still have high mortality and complication rate. Twenty eight patients underwent corrective operation for univentricular heart at Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital from February 1979 to July 1986. Of the 28 patients, 7 patients were operated on by ventricular septation and 21 patients by modified Fontan operation. Of the 28 patients, 19 patients were male and 9 patients female and ages ranged from 5 months to 18 years old with the average age of 7.3 years. There were 2 mortalities in 7 patients operated on by septation with the mortality rate of 28.6% and 5 complications, 3 complete AV block, 1 low cardiac output and 1 arrhythmia. All survived patients are being followed up without specific problem till now. There were 10 mortalities in 21 patients operated on by modified Fontan operation with the mortality rate of 47.6% and 10 complications, 2 low cardiac output, 2 respiratory failure necessitating tracheostomy, 2 persistent cyanosis, 2 arrhythmia, 1 missing of left AV valve in situs inversus patient due to misdiagnosis and one rupture of closed right AV valve. Incremental risk factors for operative mortality are young age less than 5 years old, anomalous pulmonary and systemic venous drainage and atrial septation procedure. In 11 survived patients, 9 patients show good follow-up results but one patient complains of persistent cyanosis and another one patient is suffered from CHF. In our series, results of corrective operation for univentricular heart shows continuing improvement but still high mortality and complication rate. So there must be continuing improvement in surgical result by selection of patient, by adequate decision making for timing and method of operation and by improving operative methods.

• Journal of Chest Surgery
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• v.35 no.4
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• pp.290-295
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• 2002

Backgroud: Pneumonectomy carries the possibility of numerous dangerous complications as well as the vast effect the operation itself has on the cardiopulmonary function. Most of operations are done with the insertion of the chest tubes upon completion, but because of the high incidence of pyothorax as its complications, we have tried to analyze and compare the cases without inserting the chest tubes. Material and Method: During a 5 year period from January, 1996 to December 2000, 100 cases, which were operated at the Hanyang University Hospital, were selected using the patient's charts. The age, gender, indication of operation, associated diseases, and operation site(left or right) were classified accordingly and the postoperative complications and mortality were statistically analyzed using the $\chi$ 2-test. After resecting the lung, the intrathoracic pressure was set at -15 ~ -20cm $H_2O$ using the nelaton catheter, and the thoracotomy site was then closed. The gradual collection of the fluid and blood in the thorax of the operated side, as well as the mediastinum location, were observed carefully for 4~5 days postoperatively with the aid of the simple chest x-rays. Result: Of the 100 cases, 16 cases of pulmonary tuberculosis(16%), 81 cases of lung tumor(81%), 2 cases of bronchiectasis(2%), and 1 case of aspergilloma associated bronchiectasis were noted. There were 8 mortality cases(8%), and of the 34 cases(34%), 44 complications were noted. The age, sex, and operation site(left or right) were not statistically significant with the complications. 7 of the 16 cases of pulmonary tuberculosis(44%) and 27 of the 81 cases of lung tumor(33%) had complications, but they were found not to be statistically significant. The increase of the complication rate in the pulmonary tuberculosis patients was 3.86. The evidence of postoperative bleeding was observed in 6 cases with the 3 cases being the pulmonary tuberculosis patients and the 3 cases were others. This shows that the increase in postoperative bleeding in the pulmonary tuberculosis is statistically significant(p=0.019). Of the 100 cases, there were 8 mortality cases(8%), with 5 cases from the 81 cases of the lung tumor group(6.1%), 3 cases from the 16 cases of pulmonary tuberculoses group(18.7%).

• Journal of Chest Surgery
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• v.39 no.10 s.267
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• pp.786-790
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• 2006

An anastomotic pseudoaneurysm after the aortic replacement surgery is a rare complication which could be lethal when it ruptures. So it should be corrected whenever it is found after the aortic surgery. The authors performed three surgical corrections in 2 cases. The first case is type 8 chronic aortic dissection with abdominal aortic aneurysm. After an abdominal aortic replacement, the patient developed an anastomotic pseudoaneurysm. We treated him with a thoracoabdominal aortic replacement. The second case is ruputred throacoabdominal aortic aneurysm. After a thoracoabdominal aortic replacement, the patient developed an anastomotic pseudoaneurysm in the proximal anastomosis. We treated her with aortic arch replacement. But She developed another pseudoaneurysm in the aortic root anastomotic site. So we performed secondary operation to reinforce the anastomosis. They all recovered from the operations without any complication and are being followed up.

• Journal of Chest Surgery
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• v.21 no.6
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• pp.1060-1070
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• 1988

Since Jan. 1957, 142 cases of benign esophageal stricture, 55 males and 87 females, were managed in our hospital, and their ages ranged from 3 to 77 years. old[mean 31.2yrs]. The most common cause was caustic burns and they all complained dysphagia and some loss of weight, general malaise and substernal pain, which usually appeared in 1 month to 1 year after ingestion of corrosive agents. The mid 1/3 of the thoracic esophagus was the most prevalent portion[29%] but rather evenly distributed along the entire esophagus. Operations were done on 129 patients, of whom 50 patients had ECG[esophagocologastrostomy], 5 PCG[pharyn-gocologastrostomy], 34 EG[esophagogastrostomy], 4 EJG[esophagojejunogastrostomy], 3 PG[pharyngogastrostomy], 2 esophageal end to end anastomosis and 31 Gastrostomy. There were 6 deaths in the postoperative period, so its operative mortality was 4.7%, among them 3 were ECG cases, 2 EG and 1 EJG. And 34 complications occurred so it recorded 24% complication rate. and in details in ECG 46%, PCG 60%, EG 17.6%, EJG 25%, and PG 33%. When we reviewed periodic variations, the mortality rate of the first 20 yrs. period was 6.9%, next 10yrs. 2.6% and now for last 2yrs non.

• Journal of Chest Surgery
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• v.44 no.6
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• pp.413-417
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• 2011

Background: Sleeve lobectomy for lung cancer in close proximity to or involving the carina is widely accepted. Operative morbidity and mortality rates, recurrence, and survival rates have varied considerably across studies. Materials and Methods: From March of 2005 to July of 2010, sleeve lobectomy was performed in 19 patients and pneumonectomy was performed in 20 patients. In this paper, the results of sleeve lobectomy and pneumonectomy for patients with lung cancer will be compared and evaluated. Results: There were no postoperative complications in either group, but there was one mortality in the pneumonectomy group. There was better preservation of pulmonary function in the sleeve lobectomy group than the pneumonectomy group (p=0.066 in FVC, p=0.019 in FEV1). The 3-year survival rates were 46.7% in the sleeve lobectomy group and 54.5% in the pneumonectomy group (p=0.505). The 3-year disease-free survival rates were 38% in the sleeve lobectomy group and 45.8% in the pneumonectomy group (p=0.200). Conclusion: Sleeve lobectomy for lung cancer showed low mortality, low bronchial anastomotic complication rates, and good preservation of pulmonary function.