Management of a Tracheal Tear during Laryngopharyngoesophagectomy with Gastric Pull-up

Abstract

Laceration of the posterior tracheal wall is one of the risks of transhiatal esophagectonzy. Various methods of repairing such lacerations have been described; inany of these methods involve a thoracotonzy, but some do not. We describe a case of a posterior tracheal wall tear that occurred during a laryngopharyngectoiny with a gastric pull-up. The tear was repaired with the transposedstoinach and did not require a tlzoracotonzy. The transposed stoinach was used to patch the tear and block communicatioiz between the environnzent and the nzediastinunz. Bedside endoscopic examination on postoperative day 5 revealed that the tear had healed. Key management considerations in such a circumstance include having the patient breathe without positive pressure ventilation postoperatively and keeping the tracheal luinen and stoma clear during the healing process in order to prevent the development of positive trachealpressure. With these safeguards in place, the transposed stomach approach is a safe iiiethod of repairing posterior tracheal wall tears.

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

“…5,9 However, Hulscher et al 4 have failed to demonstrate any correlation of tracheal injury with TNM stage and location of the tumor. Blind stripping of the esophagus during THE has also been implicated in the causation of tracheal tear.…”

“…15 The use of the stomach to patch the rent has been described. 9,16,17 The stomach tube abuts the tracheal rent and acts like a patch. This isolates the tear from the rest of the environment.…”

“…[4][5][6][7][8] Various methods of tracheal repair have been described. 4,5,[9][10][11][12] We herein describe our experience of managing tracheal injuries in patients undergoing esophagectomy over a period of one decade.…”