Srikanth Gadiyaram, Dr, Gaurav Singh, Dr, Yashas H Ramegowda. Sahasra Hospitals, Centre of Excellence for Gastroenterology, Bangalore, India
Introduction: Iatrogenic tracheo-bronchial injury is an uncommon complication following esophagectomy with a reported incidence of 0.6-10% 1-3. Repair of a tracheal injury encountered in a patient during thoracoscopic esophagectomy in prone position is reported.
Methods: Fifty six year old lady a case of squamous cell carcinoma of the mid thoracic esophagus underwent thoraco-laparoscopic esophagectomy in prone position following completion of neo-adjuvant chemo-radiotherapy. Per-operatively, secondary to the neo-adjuvant therapy dense adhesions were noted in the region of mid thoracic esophagus adjoining the trachea-bronchial complex. An iatrogenic rent measuring about 1x 0.75 cm resulted in the trachea at the region of carina during mediastinal lymphadenectomy. The tracheal injury was repaired primarily using a pericardial flap and further reinforced with the aid of an intercostal muscle interposition and fibrin glue. A chest tube was left in place.
Results: The total operative time was 385 min. Post-operatively she was electively ventilated for 24 hours. Chest tube did not show any air leak and was removed on post-operative day 3 after confirming lung expansion. She was discharged on post-operative day 7.
Conclusion: Iatrogenic tracheo-bronchial injury is a rare but dreaded complication of esophagectomy. These injuries can be efficiently and safely repaired using the thoracoscopic route. Both pericardial flap and intercostal muscle reinforcements can be used to further buttress the repair. Careful and limited use of energy sources during both dissection of the thoracic esophagus and mediastinal lymphadenectomy can safeguard against the occurrence of such injuries
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93932
Program Number: V155
Presentation Session: Video Loop Day 1
Presentation Type: VideoLoop