Po-Jen Ko

Treatment of esophageal perforation in a referral center in taiwan.

PurposeThe high mortality associated with esophageal perforation can be reduced by aggressive surgery and good critical care. We report our experience of treating esophageal perforation in a clinic in Taiwan.MethodsThe subjects were 28 patients who underwent surgery for a benign esophageal perforation.ResultsThe esophageal perforation was iatrogenic in 11 patients, spontaneous in 8, and caused by foreign body injury in 9. Most (22/28) of the patients were seen longer than 24 h after perforation, and 77% had empyema preoperatively. The perforation was located in the cervical area in 5 patients and in the thoracic esophagus in 23. We performed primary repair in 24 patients, esophagectomy in 3, and drainage in 1. Leakage occurred after primary repair in ten (41%) patients, resulting in one death, and two patients died of other diseases. Postoperative leakage prolonged the hospital stay but had no impact on mortality. Overall survival was 90%. Univariate analysis revealed that age, timing of treatment, and cause and location of the perforation influenced outcome, but multivariate analysis failed to identify a predictor of mortality.ConclusionsEarly diagnosis and intervention are crucial to prevent morbidity and mortality in patients with esophageal perforation. Primary repair is feasible even if the diagnosis is delayed.

Feasibility of Endoscopic Transoral Thoracic Surgical Lung Biopsy and Pericardial Window Creation

BACKGROUND The thoracic cavity approach for natural orifice transluminal endoscopic surgery (NOTES) is technically challenging. The aim of this study was to evaluate the feasibility of a transoral endoscopic technique for a surgical lung biopsy and pericardial window creation METHODS Under general anesthesia, a 12 mm incision was made over the vestibulum oris region. Under video guidance, a homemade metallic tube was introduced through the incision, extending along the pre-tracheal space to the substernal space with blunt dissection technique, and used as the entrance into the thoracic cavity. A surgical lung biopsy and a pericardial window creation were performed in 12 canines, using the transoral NOTES technique. RESULTS The transoral endoscopic surgical lung biopsy and pericardial window creation were successfully completed in 11 of the 12 canines. Intraoperative bleeding and death from an injury to the pulmonary hilum developed in one animal during the electrosurgical excision of lung tissue. CONCLUSIONS Transoral surgical lung biopsy and pericardial window creation in canine models is technically feasible and can be used as a novel experimental platform for studies of NOTES for intra-thoracic surgery.

Feasibility of transtracheal surgical lung biopsy in a canine animal model

Successful natural orifice transluminal endoscopic surgery (NOTES) procedures have been reported in animal studies. However, very little is known about the optimal approach for the application of these surgeries in the thoracic cavity. This study presents the feasibility of transtracheal evaluation of pleural cavity in a canine model using the NOTES technique.

AIRWAY STENTS IN MANAGEMENT OF TRACHEAL STENOSIS: HAVE WE IMPROVED?

Background:  Airway stenting is an alternative approach for relieving airway stenosis when lesions are inappropriate for single‐stage reconstruction. The aim of this study was to present our experience using airway stent in the management of patients with tracheal stenosis.

Risk Factors and Possible Mechanisms of Intravenous Port Catheter Migration

OBJECTIVE To identify the risk factors for catheter migration and demonstrate possible mechanisms of this migration. DESIGN Retrospective study. SETTING Chang Gung Memorial Hospital, a tertiary medical centre in Taiwan. PATIENTS Patients who underwent implantation of intravenous ports via the superior vena cava (SVC). INTERVENTIONS Procedures involving catheter placement and re-intervention for catheter migration. MAIN OUTCOME MEASURES The anatomic location of the catheter tip was confirmed by plain chest X-rays (postero-anterior view). From these plain radiographs, the distance (in cm) between the carina and catheter tip and the angle (in degrees) between the locking nut and catheter were measured. METHODS A total of 1542 procedures related to intravenous port implantation were retrospectively reviewed but only procedures involving implantation via the SVC were included in the analysis. The study group was composed of 31 interventions because of catheter migration, while the control group consisted of 1475 implantation and re-intervention procedures except those involving catheter migrations. RESULTS Shallow catheter-tip location (p < 0.0001) and the presence of lung cancer (p = 0.006) were risk factors for catheter migration. CONCLUSIONS Shallow catheter-tip location and the presence of lung cancer are risk factors for catheter migration. Strategies that ensure low catheter-tip location and avoid increased thoracic pressure may be useful preventive measures.

Feasibility of transtracheal thoracoscopy (natural orifice transluminal endoscopic surgery)

FIGURE 1. A, Endoscopic image of tracheal puncture. B, Endoscopic image o C, Endoscopic image of posterior costophrenic angle. D, Endoscopic image of From the Laboratory Animal Center, Department of Surgery, Chang Gung Memorial Hospital, and the School of Medicine Chang Gung University, Taiwan, China. Supported by the Chang-Gung Memorial Hospital, Taiwan, contract No. CMRPG371471. Disclosures: None. Received for publication Sept 16, 2009; accepted for publication Sept 22, 2009; available ahead of print Nov 30, 2009. Address for reprints: Po-Jen Ko, MD, Department of Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fu-Shing St, Guei-Shan Shiang, TaoYuan, Taiwan 333, ROC (E-mail: foreverairmail@gmail.com). J Thorac Cardiovasc Surg 2010;139:1349-50 0022-5223/

Aortic valve endocarditis presents as pseudoaneurysm of the superior mesenteric artery.

36.00 Copyright 2010 by The American Association for Thoracic Surgery doi:10.1016/j.jtcvs.2009.09.039

Treatment of infected abdominal aortic aneurysm caused by Salmonella.

Mycotic aneurysms are an important cause of morbidity and mortality in endocarditis despite advanced antibiotic therapy. Visceral artery aneurysms are uncommon and usually remain clinically silent until rupture. We now report a case of successful surgical treatment of a superior mesenteric mycotic aneurysm of the superior mesenteric artery, followed by a review of pertinent clinical information.

Feasibility of transumbilical surgical lung biopsy and pericardial window creation.

BACKGROUND We reviewed the outcomes of patients treated for nontyphoidal Salmonella-infected abdominal aortic aneurysm (AAA) treatment at a single center. METHODS This was a retrospective chart review of 26 patients with nontyphoidal Salmonella-infected AAA. Four patients underwent medical therapy alone, while 22 patients underwent surgical therapy. Revascularization method selection was dependent on preoperative antibiotic response in the surgical therapy group. RESULTS The in-hospital mortality rate for the surgical therapy group was 14%, while the rate for the medical therapy group was 100%. Overall survival for the surgical therapy group was 82%, while the reinfection rate was 9%. In the surgical therapy group, 2 patients had periaortic abscesses and underwent in situ prosthetic graft replacement; none developed graft-related complications or died in the hospital. Kaplan-Meier analysis and log-rank testing revealed no significant differences in graft-related complication and overall survival rates between in situ prosthetic graft group and extra-anatomic bypass group. Salmonella choleraesuis had a higher antimicrobial resistance rate than other isolates. The predictors of survival were clinical presentation of abdominal pain and receiving surgical therapy. CONCLUSIONS If patients with Salmonella-infected AAAs have good responses to preoperative antibiotic therapy, in situ prosthetic graft replacement is a viable revascularization method, even in the situation of periaortic abscess presentation formation.

Treatment of primary infected aortic aneurysm without aortic resection

Background. To date there are no practical platforms for performing natural orifice transluminal endoscopic surgery in the thoracic cavity. This study evaluates the feasibility of transumbilical thoracosopy for lung biopsy and pericardial window creation. Methods. Eleven dogs (6 in the nonsurvival group and 5 in the survival group) were used for this study. A homemade metallic tube was advanced into the abdominal cavity via a 12-mm umbilical incision. The metallic tube was advanced into the thoracic cavity through a subxyphoid diaphragmatic incision under video guidance. Access to the thoracic cavity was achieved by a flexible bronchoscope via the metallic tube. Surgical lung biopsy and pericardial window creation were performed using an electrocautery loop and needle knife. The animals were euthanized 20 minutes after the surgery was complete (nonsurvival group) or 14 days postsurgery (survival group) for necropsy evaluation. Results. Eight pericardial window creations and 21 of 22 preplanned lung biopsies were completed in a median time of 72.18 minutes (range 50-105 minutes). One dog in the nonsurvival group died after tension pneumothorax due to postprocedure massive air leaks. In the survival group, the postoperative period was uneventful in all 5 dogs. Autopsies revealed no signs of vital organ injury and complete healing of the diaphragmatic incision occurred in all animals. Conclusions. The study demonstrated that transumbilical thoracoscopic surgical lung biopsy and pericardial window creation is feasible. The safety and efficacy of the transumbilical approach need to be verified by a more detailed survival study.