Major Airway Injury During Esophagectomy: Experience at a Tertiary Care Center

Abstract

Laceration of trachea is a potentially morbid complication of esophagectomy. Management should be individualized based on the extent and type of laceration. The surgical strategy depends upon the index procedure. The present series describes successful management of patients with tracheal injury associated with esophagectomy.

Tracheobronchial injury in the setting of an esophagectomy for cancer: Postoperative discovery a bad omen

“…Despite postoperative complications, some severe, all three patients with an intraoperative repair of a tracheobronchial injury made a full recovery. This is consistent with previous reports . The decision to suture the defect closed was based on the size (2 cm or larger), and this is in agreement with a report by Gupta et al , who only repaired lacerations that were 3 cm or longer.…”

“…This is consistent with previous reports . The decision to suture the defect closed was based on the size (2 cm or larger), and this is in agreement with a report by Gupta et al , who only repaired lacerations that were 3 cm or longer. These authors felt that for injuries less than 2 cm, gastric tube reinforcement alone was sufficient to heal the laceration, and their patients that were managed in this fashion recovered fully.…”

“…This is despite the fact that all injuries were proximal to the carina. Interestingly, Gupta et al were successful in repairing a 5 cm laceration that extended into the right mainstem bronchus via the cervical incision. The use of a headlight and well‐positioned retractors, one on the trachea and another on the sternocleidomastoid muscle, allowed for a good exposure of the retro‐tracheal space.…”

Managing iatrogenic tracheal injury during esophagectomy

“…15 Described risk factors for iatrogenic tracheal injuries in a carcinoma esophagus patient are preoperative chemoradiotherapy, extensive lymph node dissection, peritumoral infection and abscess formation, and advanced tumors located above or at the level of the carina and trans-hiatal esophagectomy (blunt esophagectomy). 16,17 But two large trials did not show any difference when the incidence was compared between transhiatal esophagectomy and transthoracic oesophagectomy. 1,15 In our study, two injuries occurs during trans-hiatal esophagectomy and one injury during trans-transthoracic esophagectomy.…”

The possibilities for the prevention of incompetent tracheorrhaphy

“…Послеоперационный период протекал гладко, пациент был выписан на 14-е сутки. Подобные наблюдения также описал V. Gupta [22]. При разобщении трахеопищеводных свищей для укрытия швов трахеи возможно использование стенки пищевода [23].…”