title: Intraoperative Tracheal Injury.
abstract: Intraoperative tracheal injury is a rare but potentially devastating complication. Transhiatal esophagectomy should be avoided in patients with proximal esophageal tumors who underwent neoadjuvant therapy, and percutaneous tracheostomy should be avoided in patients with short, thick necks. Early recognition leads to improved outcomes. Patients present with a sudden loss in airway pressure, air leaking into the operative field, or mediastinal and subcutaneous emphysema. Treatment starts with airway control. Primary buttressed repair is recommended, through either a left cervical incision for proximal injuries or a right thoracotomy for distal injuries. Nonoperative management has been used safely in select patients injured during intubation or tracheostomy.
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, 55 Fruit Street, Blake 1570, Boston, MA 02114, USA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Lui
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, 55 Fruit Street, Blake 1570, Boston, MA 02114, USA. Electronic address: cdwright@partners.org.
authors.forename: Cameron
authors.initials: C
authors.lastname: Wright
mesh_terms: D016629:Esophagectomy / Q000009:adverse effects*; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000628:therapy; D007442:Intubation, Intratracheal / Q000009:adverse effects; D013908:Thoracotomy / Q000379:methods; D014132:Trachea / Q000293:injuries* / Q000601:surgery; D014139:Tracheostomy / Q000009:adverse effects
keywords: Esophagectomy complications; Percutaneous tracheostomy complications; Tracheal injury; Tracheal repair