Reconstructive surgery for combined tracheo-esophageal injuries and their sequelae

Objective: To evaluate surgical options of treatment in combined tracheo-es ophageal injuries and their sequelae and elaborate new ones. Methods: The o verlooked diagnosis of combined tracheo-esophageal injury would lead to sev ere stenosis of the esophagus and trachea with tracheo-esophageal fistula. This condition requires a complex surgical intervention to be per-formed wi th non-standard procedure in every single case. Forty patients with combine d tracheo-esophageal injuries were treated in our institution. Nine patient s were urgently operated while others were transferred to us from other hos pitals with chronic sequelae of the initial trauma. Results: In the majorit y of cases the cause of the injury was penetrating (17 patients) or iatroge nic (13 patients) trauma followed by blunt neck and chest trauma (six patie nts) and caustic burn (four patients). Three patients had total cut off of the esophagus and trachea, which were repaired with end-to-end anastomoses. Another six patients had tracheal and esophageal disruptions within one-ha lf to three-quarters of circumference. In these cases both the trachea and esophagus were mobilized within wall laceration and sutured by interrupted Vicryl (R) 4/0. One of them died due to pre-existing disease. Thirty-one pa tients with sequelae of the trauma were also operated on. In spite of the c omplexity and extent of the tracheoesophageal stenosis and fistula the surg ical treatment was aimed to one-stage reconstruction of both the esophagus and trachea. For this purpose we performed an originally developed surgical intervention, which was to be modified in accordance with patients diagnos is. The main point of the procedure is that after mobilization of the trach ea and esophagus we resect an involved part of the trachea, but preserve a pedicled flap fashioned from the tracheal membrane. Then we remove the muco sa from the flap, resect an involved esophageal wall, repair esophageal muc osa and replace the defect of the muscular layer of the esophagus with the tracheal flap. Then a tracheal or laryngo-tracheal anastomosis is establish ed. There were no postoperative mortality and complications among patients with the sequelae. Conclusion: Combined tracheo-esophageal injury requires the precise preoperative diagnosis and well organized plan of surgical trea tment, which may be unique for every single patient. The main purpose of th e treatment is to restore the continuity of both the esophagus and trachea in one-stage intervention. (C) 2001 Elsevier Science B.V. All rights reserv ed.