title: An unusual salvage technique for posterior tracheal membranous laceration associated with transhiatal esophagectomy: A transcervical-transsternal approach.
abstract: Various surgical approaches may be employed for esophageal resection. Major airway injuries due to transhiatal esophagectomy include vertical tears in the membranous trachea. Tracheal injury is an uncommon but potentially fatal complication. This article describes the technique to repair the posterior membranous tracheal tear, extended just over the carina through a transcervical-transsternal approach, thereby avoiding a second thoracotomy. Six patients with posterior membranous tracheal injury underwent this procedure. The laceration ranged from 3 cm to 5 cm in length. Four patients had received neoadjuvant chemoradiation. The management of tracheal laceration added approximately 60 minutes to the total operation time. There was no mortality related to tracheal injury. Patients were followed up for 6 months after surgery, and both posterior tracheal wall and transverse tracheotomy remained intact without stenosis. The transcervical-transsternal approach decreases the need of thoracotomy and its complications in patients with tracheal laceration in any stage, even in cases of an extended tear down to the carina.
authors.affiliation: Department of Cardiothoracic Surgery, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Seyed Ziaeddin
authors.initials: SZ
authors.lastname: Rasihashemi
authors.affiliation: Department of Radiology, University of Minnesota Medical Center, Minneapolis, MN, USA.
authors.forename: Nassir
authors.initials: N
authors.lastname: Rostambeigi
authors.affiliation: Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Seyed Reza
authors.initials: SR
authors.lastname: Saghebi
authors.affiliation: Student Research Committee & Medicine Faculty, Daneshgah street, 5183915881, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Faeze
authors.initials: F
authors.lastname: Daghigh
authors.affiliation: Student Research Committee & Medicine Faculty, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: ali.ramouz@gmail.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Ramouz
mesh_terms: D000368:Aged; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D022125:Lacerations / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D014132:Trachea / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome
keywords: esophagectomy; laceration; trachea; transcervical; transhiatal