title: 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 esophagectomy. Various methods of repairing such lacerations have been described; many of these methods involve a thoracotomy, but some do not. We describe a case of a posterior tracheal wall tear that occurred during a laryngopharyngectomy with a gastric pull-up. The tear was repaired with the transposed stomach and did not require a thoracotomy. The transposed stomach was used to patch the tear and block communication between the environment and the mediastinum. 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 lumen and stoma clear during the healing process in order to prevent the development of positive tracheal pressure. With these safeguards in place, the transposed stomach approach is a safe method of repairing posterior tracheal wall tears.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Koterski
authors.forename: Norman
authors.initials: N
authors.lastname: Snow
authors.forename: Mike
authors.initials: M
authors.lastname: Yao
mesh_terms: D000368:Aged; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery; D007825:Laryngectomy / Q000009:adverse effects*; D008297:Male; D010611:Pharyngectomy / Q000009:adverse effects*; D012421:Rupture / Q000209:etiology; D013270:Stomach; D014132:Trachea / Q000293:injuries*