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Intraoperative tracheal reconstruction with bovine pericardial patch following iatrogenic rupture.

Barbetakis N, Samanidis G, Paliouras D, Lafaras C, Bischiniotis T, Tsilikas C - Patient Saf Surg (2008)

Bottom Line: Tracheal injury was successfully managed surgically with the use of bovine pericardial patch and reinforcement with the gastric conduit which was moved toward the posterior wall of the membranous trachea sealing the wall laceration.Our technique was proved to be safe, effective and not technically demanding.Early recognition with prompt surgery is the gold standard of managing such cases, although small tears can be managed conservatively.

View Article: PubMed Central - HTML - PubMed

Affiliation: Thoracic Surgery Department, Theagenio Cancer Hospital, A, Simeonidi 2, Thessaloniki, 54007, Greece. nibarb@otenet.gr.

ABSTRACT

Introduction: Iatrogenic injuries of the membranous trachea have become increasingly common and may trigger a cascade of immediate life-threatening complications.

Case presentation: A case of a 48-year-old man with an iatrogenic membranous tracheal wall rupture after double-lumen intubation during Ivor Lewis esophagogastrectomy is presented. Tracheal injury was successfully managed surgically with the use of bovine pericardial patch and reinforcement with the gastric conduit which was moved toward the posterior wall of the membranous trachea sealing the wall laceration.

Conclusion: Our technique was proved to be safe, effective and not technically demanding. Early recognition with prompt surgery is the gold standard of managing such cases, although small tears can be managed conservatively.

No MeSH data available.


Related in: MedlinePlus

Oval-shaped laceration (arrow) of membranous trachea extended to 1 cm above the carina.
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Figure 1: Oval-shaped laceration (arrow) of membranous trachea extended to 1 cm above the carina.

Mentions: The abdominal part of the operation was uneventful. During the second phase and while the intrathoracic esophagus was being mobilized a hissing noise was heard and a careful inspection revealed part of the double-lumen tube and the inflated tracheal cuff protruding through the ruptured membranous tracheal wall into the operating field. This resulted in an approximately 3 × 1 cm oval-shaped laceration of membranous trachea, extending to 1 cm above the carina (Figure 1). The ventilation and oxygenation of the patient could now only be continued by occlusion of the tear by the surgeon's finger and subsequently by a surgical gauze swab. Our first attempt was primary interrupted suturing which failed and resulted in enlargement of the laceration probably due to the previous chemoradiotherapy. Tracheal repair was then performed by tailoring and suturing a bovine pericardial patch, using a running Vicryl 4-0 suture. This led to control of the leakage and normal ventilation was re-instituted. The main operation was completed by performing a classical Ivor Lewis esophagogastrectomy with a 2-field lymphadenectomy. Esophagogastric continuity was restored with an end-to-end anastomosis using an EEA 25 mm circular stapling device.


Intraoperative tracheal reconstruction with bovine pericardial patch following iatrogenic rupture.

Barbetakis N, Samanidis G, Paliouras D, Lafaras C, Bischiniotis T, Tsilikas C - Patient Saf Surg (2008)

Oval-shaped laceration (arrow) of membranous trachea extended to 1 cm above the carina.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2267446&req=5

Figure 1: Oval-shaped laceration (arrow) of membranous trachea extended to 1 cm above the carina.
Mentions: The abdominal part of the operation was uneventful. During the second phase and while the intrathoracic esophagus was being mobilized a hissing noise was heard and a careful inspection revealed part of the double-lumen tube and the inflated tracheal cuff protruding through the ruptured membranous tracheal wall into the operating field. This resulted in an approximately 3 × 1 cm oval-shaped laceration of membranous trachea, extending to 1 cm above the carina (Figure 1). The ventilation and oxygenation of the patient could now only be continued by occlusion of the tear by the surgeon's finger and subsequently by a surgical gauze swab. Our first attempt was primary interrupted suturing which failed and resulted in enlargement of the laceration probably due to the previous chemoradiotherapy. Tracheal repair was then performed by tailoring and suturing a bovine pericardial patch, using a running Vicryl 4-0 suture. This led to control of the leakage and normal ventilation was re-instituted. The main operation was completed by performing a classical Ivor Lewis esophagogastrectomy with a 2-field lymphadenectomy. Esophagogastric continuity was restored with an end-to-end anastomosis using an EEA 25 mm circular stapling device.

Bottom Line: Tracheal injury was successfully managed surgically with the use of bovine pericardial patch and reinforcement with the gastric conduit which was moved toward the posterior wall of the membranous trachea sealing the wall laceration.Our technique was proved to be safe, effective and not technically demanding.Early recognition with prompt surgery is the gold standard of managing such cases, although small tears can be managed conservatively.

View Article: PubMed Central - HTML - PubMed

Affiliation: Thoracic Surgery Department, Theagenio Cancer Hospital, A, Simeonidi 2, Thessaloniki, 54007, Greece. nibarb@otenet.gr.

ABSTRACT

Introduction: Iatrogenic injuries of the membranous trachea have become increasingly common and may trigger a cascade of immediate life-threatening complications.

Case presentation: A case of a 48-year-old man with an iatrogenic membranous tracheal wall rupture after double-lumen intubation during Ivor Lewis esophagogastrectomy is presented. Tracheal injury was successfully managed surgically with the use of bovine pericardial patch and reinforcement with the gastric conduit which was moved toward the posterior wall of the membranous trachea sealing the wall laceration.

Conclusion: Our technique was proved to be safe, effective and not technically demanding. Early recognition with prompt surgery is the gold standard of managing such cases, although small tears can be managed conservatively.

No MeSH data available.


Related in: MedlinePlus