• Korean Journal of Bronchoesophagology
• /
• v.5 no.2
• /
• pp.143-152
• /
• 1999

Background : the technical modality of esophagogastric anastomosis plays an important part in the factors leading to anastomotic leakage and stricture. Objective : The objective of this study was to compare the leakage and stricture rates between the different anastomosis techniques. Materials and Methods : A retrospective study was undertaken in the patients with esophageal cancer who underwent a esophagectomy. Hand-sewn anastomosis was performed in one layer with interrupted sutures(Manual group). The stapler group was divided into two subgroups, such as PCEEA group and Endo-GIA group. Results : The differences of preoperative patient profiles between the groups were not significant. Overall mortality fates were 5% in manual group, 5% in PCEEA group and 11.5% in Endo-GIA group. Fewer anastomotic leakage occurred in manual group(5%) than in PCEEA group(10%) or in Endo-GIA group(15.4%). The postoperative stricture rate was higher in PCEEA group(35%) than in manual group(5%) or in Endo-GIA group(0%) Conclusion : Statistically, there were no significant differences in the anastomotic leakage and stricture rates between the hand-sewn and mechanical anastomosis. But the stricture rate was lower in the group using the linear stapling device and the leakage rate was lower in the hand-sewn group than the other groups.

• Archives of Plastic Surgery
• /
• v.32 no.5
• /
• pp.671-673
• /
• 2005

Difficulties with intraoperative fixation of hair or eyebrow sometimes occur because of displacement or dislodgment of hair during surgery. So we have found that the simple application of a small transparent adhesive disposable dressing, such as $Tegaderm^{(R)}$ or OpSite $Flexigrid^{(R)}$, can prevent this. One of the advantages of this technique, compared with stapler fixation of the hair, is that it does not cause local trauma. An OpSite $Flexigrid^{(R)}$ or $Tegaderm^{(R)}$ is placed such that it covers both the scar and operation site hair. The hair or eyebrow were easily, quickly, and firmly positioned even on the nonshaved scalp. The technique seems to have no drawbacks, and when the $Tegaderm^{(R)}$ or Opsite $Flexigrid^{(R)}$ is removed, patient experiences little discomfort. We have never seen an allergic or direct traumatic cutaneous response following the use of these materials.

• Journal of Chest Surgery
• /
• v.36 no.1
• /
• pp.51-54
• /
• 2003

This patient was an 53-year-old man who had undergone Sengstaken-Blackmore tube insertion for esophageal varix bleeding. Two days after Sengstaken-Blackmore tube insertion, he developed severe left hemothorax and was transferred to our hospital. The esophagoscopic findings revealed a large perforation lengthening 8-cm in the intrathoracic esophagus. A left thoracotomy was performed 33 days after the injury due to repeated varix bleedings and poor conditions. An 8-cm longitudinal perforation of the intrathoracic esophagus with gross suppurative empyema was found. Primary repair and esophageal exclusion was performed 2cm proximal and distal to the perforation, using rows of nonabsorbable staplers(TA stapler 60 $\times$ 4.8) and large bore thoracostomy tubes were placed for local drainage. Six days after intrathoracic esophageal exclusion, an esophagogram revealed a leakage at just above the proximal stapling site. A cervical esophageal exclusion was performed using the same method. One hundred thirty seven days after exclusion operation for the intra-thoracic esophageal perforation, the patient was able to eat per orally without any secondary esophageal reconstructive surgery.

• Journal of Gastric Cancer
• /
• v.7 no.3
• /
• pp.132-138
• /
• 2007

Purpose: In Korea, the number of laparoscopy-assisted distal gastrectomies for early gastric cancer patients has been on the increase. Although minimally invasive surgery is more beneficial, no reported case of a total laparoscopic gastrectomy has been reported because of difficulty with intracorporeal anastomosis. This study attempts, through our experience, to determine the safety and feasibility of a total laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linears stapler in treating early gastric carcinomas. Materials and Methods: We investigated the surgical results and clinicopatholgical characteristics of 81 patients that underwent a totally laparoscopic distal gastrectomy at our department between June 2004 and May 2007. The intracorporeal anastomoses were performed by using laparoscopic linear staplers. Results: The mean operative time was 287 minutes, the mean anastomotic time was 40 minutes, and the mean number of laparoscopic linear staplers used for an operation was 7.5. The mean time to the first flatus, the first food intake, and discharge from hospital was 2.9, 3.6, and 10.3 days respectively. There were 11 cases of postoperative complications, but no case of postoperative mortality or conversion to an open procedure. In 75 patients with an adenocarcinoma, the mean number of lymph nodes harvested was 38.1 and the stage distribution was as follows: stage I, 72 patients; stage II, 2 patients; stage IV, 1 patient. During the mean follow-up period of 14 months, 5 patients died of other causes and there were no cases of cancer recurrence. Conclusion: A total laparoscopic gastrectomy with intracorporeal anastomosis by using a laparoscopic linear stapler was found to be safe and feasible. We were able to obtain acceptable surgical outcomes in terms of minimal invasiveness.

• Journal of Chest Surgery
• /
• v.26 no.4
• /
• pp.325-328
• /
• 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
• /
• v.41 no.5
• /
• pp.625-629
• /
• 2008

Background: When it comes to esophageal cancer operations, the prevalence of anastomotic complications that adversely affect quality of life is related to the type of anastomotic procedure and the operative site. We studied outcomes related to a safe anastomotic method used in Ivor Lewis esophagogastrectomy for preventing anastomotic leakage and stricture formation. Material and Method: Between May 2003 and April 2007, 18 patients with esophageal cancer underwent this type of esophagogastrectomy. Four people were lost to follow-up. There were 17 men (94.4%) and 1 woman. The mean patient age was 61 years (range, $46{\sim}73$ years). Result: The mean follow-up period was 17.2 months (range, $1{\sim}45$ months). There was no anastomotic leakage. There was one benign anastomotic stricture (5.6%) requiring esophageal balloon dilatation, which was accomplished with a 25 mm circular stapler. Conclusion: We experienced relatively good postoperative results using a safe anastomotic method in the Ivor lewis operation for preventing anastomotic complications. These results suggest that this anastomotic method is effective in reducing the incidence of benign anastomotic complications.

• Journal of Chest Surgery
• /
• v.54 no.3
• /
• pp.206-213
• /
• 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.

• Journal of Gastric Cancer
• /
• v.4 no.2
• /
• pp.121-125
• /
• 2004

Purpose: Esophagojejunal anastomotic complications after a total gastrectomy include leakage, stenosis, bleeding, and abscess formation. Especially, the mortality rate for esophagojejunal anastomotic leakage is $80\%$. Although these complications hare been reduced by the usage of the EEA stapler, they are still serious and depend on various factors: the surgeon's experience, the stage of disease, the extent of surgical intervention, the method of operation, and the patient. Some local factors, such as vascularization of the graft, traction on the anastomosis suture line, and local infections, have been implicated as contributing to these complications. Materials and Methods: During the period $1995\∼2003$, of the 850 gastrectomies for gastric carcinomas, 171 were intra-abdominal total gastrectomies. All of these 171 operations were performed by one surgeon using a routine D2 lymph-node dissection and a 25-mm EEA stapler on an antecolic end-to-side esophagojejunostomy. In the 77 cases a seromuscular reinforced suture at the esophagojejunostomy site was performed, and in 94 cases, a whole layer reinforced suture with absorbible materials was used. We evaluated the incidence of complications according to age, sex, stage of patients, and combined resection. Also, we compared the incidences of complications for seromuscular and whole layer reinforced sutures. Results: The complications are major leaks ($2.9\%$), minor leaks ($3.5\%$), stenosis, bleeding ($1.8\%$), and abscess formation formation ($1.8\%$). In the five cases of major leaks, there were four mortalities with operative methods. The other patients with stenosis, bleeding, and abscess formation were treated conservatively with success. The incidences of complications were not related with age, sex, stages, and combined resection. The incidences of complications for the whole layer reinforced suture group ($2.9\%$) were less than those for the seromuscular reinforced group ($8.8\%$, P=0.04). Conclusion: The most serious complication of esophagojejunal anastomosis is major leakage with an $80\%$ mortality. The other complications are stenosis, bleeding, and abscess formation, for which no mortalities occurred during this study. Whole layer suture of the esophagojejunal anastomotic site is an important method for preventing leakage.

• Journal of Chest Surgery
• /
• v.10 no.2
• /
• pp.190-194
• /
• 1977

An analysis of 503 pulmonary resection is presented, with the following points of interest; 1] By using a stapling device, the operation time is shortened, more lung tissue can be saved, and post-operative complications are fewer. 2] By comparison with a previous series, postoperative drainage from the chest is decreased when the stapling device is used. In the present series 82% of patients has less than 500 cc of drainage post-operatively. Average required whole blood replacement was less than 800 cc in this series of patients. 3] Only 13 patients, or 2.6% developed a bronchopleural fistula, and only 8 patients, or 1.5% developed post-operative empyema when the stapling device was used. 4] Because of the decreased air leaks when the stapling device is used, the anterior and posterior tubes can be removed sooner. 5] With careful preservation of lung tissue and paralysis of the phrenic nerve, post operative `dead space" is not a problem after the pulmonary lobectomy. Thus thoracoplasty is not necessary to eliminate "dead space".

• Journal of Chest Surgery
• /
• v.31 no.10
• /
• pp.995-998
• /
• 1998

Background: Prolonged air leak is a common complication after thoracoscopic bullectomy. Materials and methods: A technique is described to minimize postoperative air leak in thoracoscopic surgery for the treatment of recurrent or persistent spontaneous pneumothorax. Results: A 3.5cm utility incision is made in the anterior axillary line at the level of the third intercostal space, and blebs and bullae are stapled and sutured without excision, using standard surgical instruments and stapler. Conclusions: This technique may be useful to reduce prolonged air leak after removal of the bleb and bullous lesion, and may minimize the delayed recurrence of ipsilateral pneumothorax.