• Journal of Chest Surgery
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• v.26 no.4
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• pp.325-328
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• 1993

The pedicled omental flap has been used for treatment of various kind of complications in thoraxcic surgery. Its property of promoting neovascularization , immunilogic properties that limiting the spread of infection, providing soft tissue coverage are very effective in treatment esophageal fistulas. Also, congenital broncho-esophageal fistula [ BEF ] is a rare disease entity which was reported about 100 cases around the world. We experienced 27 years old female patient with Braimbridge type I congenital BEF. We performed division of BEF using stapler and pericardial patch coverage of esophageal side with concomittent left lower lobectomy. This patient was complicated with postoperative esophageal leakage with empyema thoracis. We have successfully managed these problems with re-thoracotomy and re-closure of esophageal fistula using Right Gastroepiploic Artery based pedicled omental flap wrapping around the esophageal anastomosis site. It is felt that pedicled omental flap is a very effective method to manage esophageal complication such as postoperative esophageal leakage.

• Journal of Chest Surgery
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• v.53 no.4
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• pp.191-199
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• 2020

Surgeons recommend dissecting lymph nodes in the thorax, abdomen, and neck during surgery for esophageal cancer because of the possibility of metastasis to the lymph nodes in those areas through the lymphatic plexus of the esophageal submucosal layer. Extensive lymph node dissection is essential for accurate staging and is thought to improve survival. However, it can result in several complications, including chyle leakage, which refers to continuous lymphatic fluid leakage and can occur in the thorax, abdomen, and neck. Malnutrition, fluid imbalance, and immune compromise may result from chyle leakage, which can be potentially life-threatening if it persists. Therefore, various treatment methods, including conservative treatment, pharmacological treatment such as octreotide infusion, and interventions such as thoracic duct embolization and surgical thoracic duct ligation, have been applied. In this article, the risk factors, diagnosis, and treatment methods of chyle leakage after esophagectomy are reviewed.

• Journal of Chest Surgery
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• v.14 no.1
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• pp.77-82
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• 1981

The esophageal perforation is the most rapidly fatal and most serious perforation of the gastrointestinal tract. The 53 year old male patient was admitted because of substernal and epigastric pain altar esophageal bougienage for the indigestion and the difficult swallowing before about 18 hours. On esophagogram, there was the extravasation of contrast media at the right side of the lower esophagus [retrocardiac segment]. The emergency thoractotomy, debridement and suture closure with drainage were performed. But after 7 days the esophageal leakage was complicated again with pus discharge, although primary repair was done. On the 13th hospital day, the temporary cervical esophageal fistulation with dual drainages was made under general anesthesia. On the 38th day after this procedure, the esophageal leakage was closed spontaneously. On the 63rd hospital day the cervical fistulation was repaired and ever since the esophageal passage was good without leakage or swallowing difficulty.

• Journal of Chest Surgery
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• v.51 no.1
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• pp.76-80
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• 2018

Early diagnosis followed by primary repair is the best treatment for spontaneous esophageal perforation. However, the appropriate management of esophageal leakage after surgical repair is still controversial. Recently, the successful adaptation of vacuum-assisted closure therapy, which is well established for the treatment of chronic surface wounds, has been demonstrated for esophageal perforation or leakage. Conservative treatment methods require long-term fasting with total parenteral nutrition or enteral feeding through invasive procedures, such as percutaneous endoscopic gastrostomy or a feeding jejunostomy. We report 2 cases of esophageal leakage after primary repair treated by endoscopic vacuum therapy with continuous enteral feeding using a Sengstaken-Blakemore tube.

• Journal of Chest Surgery
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• v.52 no.4
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• pp.227-231
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• 2019

Background: There is no established surgical procedure for the treatment of epiphrenic esophageal diverticulum. The aim of this study was to compare the clinical outcomes of esophageal diverticulectomy using abdominal and thoracic approaches. Methods: We retrospectively reviewed 30 patients who underwent esophageal diverticulectomy through the thoracic or abdominal approach for an epiphrenic diverticulum at a single center between 1996 and 2018. We compared clinical outcomes, including the postoperative length of stay, time from the operation to oral feeding, leakage rate, and reoperation rate between the 2 groups. Results: The median age was 56 years. Of the 30 patients, 18 (60%) underwent diverticulectomy via the thoracic approach and 12 (40%) underwent the abdominal approach. The median hospital stay was 10 days (range, 5-211 days) in the thoracic approach group and 9.5 days (range, 5-18 days) in the abdominal approach group. The median time from the operation until oral feeding was 6.5 days (range, 3-299 days) when the thoracic approach was used and 5 days (range, 1-11 days) when the abdominal approach was used. In the thoracic approach group, the leakage rate was 16.67% and the reoperation rate was 27.78%. However, there were no cases of leakage or reoperation in the abdominal approach group. Conclusion: The abdominal approach for esophageal diverticulectomy is a feasible and appropriate alternative to the thoracic approach.

• Journal of Chest Surgery
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• v.31 no.7
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• pp.711-717
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• 1998

Background: Although various anastomotic techniques and suture materials have been used in esophageal anastomosis, anastomotic leakage and stenosis are still somewhat frequent and serious complications when compared to other intestinal anastomoses. We have used interrupted single-layer suture technique using monofilament polypropylene suture in various esophageal anastomoses, including repair of the esophageal atresia, since 1990. Methods and method: We retrospectively evaluated the efficacy of this technique on postoperative leakage and stenosis in several esophageal reconstructions. The esophageal reconstructions using this technique were performed in 90 patients at Dong-A University Hospital from April 1990 through December 1996. Results: Anastomotic leakage occurred in 5 patients(5.6%) with one operative death. Stenosis at the anastomotic site occurred in 15 patients(n=86, 17.4%), which was most common in esophagogastrostomy(22%) and least common in esophagocolostomy (5%). This result was comparable to other methods including the autosuture technique. Conclusions: We concluded that this suture technique in esophageal anastomosis can be used with reasonable results in various esophageal reconstructions including correction of the esophageal atresia.

• Journal of Chest Surgery
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• v.24 no.5
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• pp.463-469
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• 1991

Post-anastomotic leakage and stenoses remain major complications and are still responsible for many mortalities after esophageal reconstructive procedures. If the hand-suture is used, anastomotic leaks developed frequently than stenoses. But post-anastomotic leakages are more critical than post-anastomotic stenoses. If the stapler is used, anastomotic stenoses will develop frequently and not critical than anastomotic leakages. The stapler suture method is easier and quicker than the hand suture method in the esophageal anastomotic procedures. But the disadvantages of the stapler suture method is that there is not reachable site with anastomotic stapler the thoracic inlet region and the cost is expensive. We have treated 44 cases of the surgical complications after esophageal reconstructive procedure with conservative and surgical treatment for 10 years from January, 1980 to December, 1989. The anastomotic site stenoses were 8 cases in the hand-suture methods and 4 cases in the stapler-suture methods. The anastomotic leaks were 8 cases in hand-suture methods and 5 cases in stapler-suture methods. There were one death in the surgical repair of four post-operative anastomotic stenoses and two deaths in the surgical repair of three post-operative anastomotic leakages. Ever though we consider that there is more anastomotic leakage than stenoses after the hand-suture methods in esophageal reconstructive procedures. the cost with long stay in the intensive care unit to treat anastomotic leakage after the hand-suture, would be more expensive than-the cost of the treatment of the anastomotic stenoses after auto-suture.

• Journal of Chest Surgery
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• v.56 no.5
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• pp.362-366
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• 2023

The stomach has become the most commonly used site for grafts to replace the esophagus in esophageal cancer surgery because of its good blood supply and ability to enable single-reconstruction anastomosis. However, anastomotic failure is a serious complication after esophageal cancer surgery. Unlike anastomotic leakage due to local ischemia, gastric tube necrosis is a life-threatening condition with a high mortality rate. Gastric tube necrosis involves extensive ischemia due to a decreased blood supply, and an urgent operation is mandatory in most cases. Endoscopic vacuum therapy (EVT) has been used for anastomotic leakage after esophageal surgery. In recent years, it has been successfully used for more extensive disease, including large esophageal perforation as an indication for reoperation. Hence, we report a case of extensive gastric tube necrosis treated by EVT after an Ivor Lewis operation.

• Journal of Chest Surgery
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• v.17 no.2
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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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• v.27 no.8
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• pp.714-716
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• 1994

Perforation of the esophagus, with any of its possible consequences, consetitutes an emergeny. We are reporting one case of transhiatal esophagectomy with esophagogastrostomy. The cause of esophageal perforation was baloon dilatation with underlying stricture. We recognized immediately intrathoracic perforation through routin check of Chest PA and confrormed dye leakage through esophagogram. She underwent emergency operation.