Use of omentum for mediastinal tracheostomy after total laryngoesophagectomy

Background. Carcinomas of the cervicothoracic esophagus frequently invade t he trachea and complete removal of the tumor often requires mediastinal tra cheostomy. Traditionally, this surgical management was associated with high morbidity and mortality. Several types of myoctaneous flaps have been used for mediastinal tracheostomy to reduce the complication. We present our ex perience with a new technique for construction of mediastinal tracheotomy a fter total laryngoesophagectomy and reconstruction with the stomach. Methods. The anterior chest wall was amply resected and the distal end of t he trachea was placed low between the superior vena cava and aortic arch. W e mobilized the entire omentum with the stomach and brought them up to the neck through the posterior mediastinum. The omentum was put around the trac hea, main arteries, and the anastomosis. Results. Seven mediastinal tracheostomies were performed using this method, There was no hospital death. Complications included respiratory failure (2 patients) and pyothorax (1 patient). Anastomotic leakage and inominate art ery rupture were not experienced. Postoperative survival was disease depend ent. All patients were discharged with satisfactory oral food intake, good airway condition, and excellent cosmetic appearance. Conclusions. We suggest the use of the omentum as a simple and reliable tec hnique in constructing mediastinal tracheostomy following total laryngoesop hagectomy for cervicothoracic esophageal cancer. (C) 2001 by The Society of Thoracic Surgeons.