scholarly journals Esophageal Trachea, a Unique Foregut Malformation Requiring Multistage Surgical Reconstruction: Case Report

2020 ◽  
Vol 8 ◽  
Author(s):  
Roberto Tambucci ◽  
Océane Wautelet ◽  
Astrid Haenecour ◽  
Geneviève François ◽  
Christophe Goubau ◽  
...  
Keyword(s):  
Median Sternotomy ◽  
Oral Feeding ◽  
Surgical Reconstruction ◽  
Esophageal Reconstruction ◽  
Surgical Approaches ◽  
Long Distance ◽  
Esophageal Tissue ◽  
Diseased Segment ◽  
Foregut Malformation ◽  
Long Gap Esophageal Atresia

Abnormal connections between the esophagus and low respiratory tract can result from embryological defects in foregut development. Beyond well-known malformations, including tracheo-esophageal fistula and laryngo-tracheo-esophageal cleft, rarer anomalies have also been reported, including communicating bronchopulmonary foregut malformations and tracheal atresia. Herein, we describe a case of what we have called “esophageal trachea,” which, to our knowledge, has yet to be reported. A full-term neonate was born in our institution presenting with a foregut malformation involving both the middle esophagus and the distal trachea, which were found to be longitudinally merged into a common segment, 3 cm in length, located just above the carina and consisted of esophageal tissue without cartilaginous rings. At birth, the esophagus and trachea were surgically separated via right thoracotomy, the common segment kept on the tracheal side only, creating a residual long-gap esophageal atresia. The resulting severe tracheomalacia was treated via simultaneous posterior splinting of such diseased segment using an autologous pericardium patch, as well as by anterior aortopexy. Terminal esophagostomy and gastrostomy were created at that stage due to the long distance between esophageal segments. Between ages 18 and 24 months, the patient underwent native esophageal reconstruction using a multistage traction-and-growth surgical strategy that combined Kimura extra-thoracic esophageal elongations at the upper esophagus and Foker external traction at the distal esophagus. Ten months after esophageal reconstruction, prolonged, refractory, and severe tracheomalacia was further treated via anterior external stenting using a semitubular ringed Gore-Tex® prosthesis, through simultaneous median sternotomy and tracheoscopy. Currently, 2 years after the last surgery, respiratory stabilization, and full oral feeding were stably achieved. Multidisciplinary management was crucial for assuring lifesaving procedures, correctly assessing anatomy, and planning for multiple sequential surgical approaches that aimed to restore long-term respiratory and digestive functions.

DOZ047.99: A unique case of ‘esophageal trachea’ requiring a multistep sequential surgical reconstruction

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
R Tambucci ◽  
O Wautelet ◽  
G François ◽  
A Haenecour ◽  
C Goubau ◽  
...  
Keyword(s):  
Common Duct ◽  
Median Sternotomy ◽  
Oral Feeding ◽  
Surgical Reconstruction ◽  
Esophageal Reconstruction ◽  
Surgical Approaches ◽  
Distal Stump ◽  
Esophageal Tissue ◽  
Gastric Transposition ◽  
Long Gap Esophageal Atresia

Abstract Introduction Communicating bronchopulmonary foregut malformations (CBPFMs) have been defined by Srikanth et al. in 1992 as a fistula between a portion of respiratory tissue and esophagus/stomach. Four types of CBPFMs have been described, none of those contemplating a complete communication between the distal trachea and esophagus. Case Report This study reports a case of a full-term neonate presenting with a VACTERL association and a tracheoesophageal malformation characterized by the presence of a long common duct including both the middle esophagus and distal trachea, which consists in esophageal tissue, without any cartilaginous rings 3–4 cm above the carina. A few days after birth, the esophagus and trachea have been surgically separated, keeping the common duct on the tracheal side and creating a residual long-gap esophageal atresia (LGEA). The resulting severe tracheomalacia has been simultaneously treated by posterior splinting using an autologous pericardium patch, as well as by anterior aortopexy. A terminal esophagostomy and a gastrostomy have been created to postpone esophageal reconstruction. Since the age of 18 months, delayed repair of LGEA has been performed by using a multistep strategy consisting of a combination of Kimura extrathoracic esophageal elongations and distal stump Foker external traction. Since no cartilaginous rings were present, refractory tracheomalacia has been further treated by a tracheoplasty through a combined median sternotomy and tracheoscopy approach at the age of 3 years by using a semitubular rigid Gore-Tex® prosthesis for an anterior external stenting. Today, 9 months after last surgery, complete weaning from respiratory support has been stably achieved, as well as full oral feeding. Conclusions This is the first description of an ‘esophageal trachea’, which may be considered as a new anatomic variant of CBPFMs. Multidisciplinary medical and surgical expertise was needed to manage this particular case, in order to properly plan multiple sequential surgical approaches. Native esophageal reconstruction should always be considered, even because colonic or gastric transposition might further affect severe tracheomalacia, resulting in more challenging treatment.

DOZ047.29: Pleural flap for partial esophageal substitution in case of difficult anastomosis

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
S De Napoli Cocci ◽  
S Faraj ◽  
A Guinot ◽  
S Joseph ◽  
D Caldari ◽  
...  
Keyword(s):  
Oral Feeding ◽  
Esophageal Reconstruction ◽  
Esophageal Wall ◽  
Parietal Pleura ◽  
Partial Reconstruction ◽  
Esophageal Tissue ◽  
Complications Of Surgery ◽  
Esophageal Substitution ◽  
Anterior Plane

Esophageal reconstruction in long-gap atresia remains challenging for the surgeon. Complications of surgery, regardless of choices and methods proposed, are frequents, sometimes serious, and can significantly delay baby's feeding, with increased disruption of orality. The ideal is a reconstruction with only esophageal tissue available. There is renewed interest for technical of elongation described initially by Foker, especially modified by Van Der Zee.1 But, elongation is not always so simple that provided. We report an observation of esophageal atresia (type 1 Ladd), treated by rapid elongation. On the sixth day of procedure, right pleurisy reveals a rip at the apex of inferior esophagus. Anastomosis was possible on the posterior plane, but impossible on the anterior plane. The anterior plane has been reconstituted with a flap of parietal pleura. The operative course was simple without any fistula. Oral feeding started at fifteenth day postanastomosis was quickly complete. Gastrostomy left by security has not been used. Three endoscopic dilations have been necessary at six weeks, two and five months after anastomosis. At the age of eleven months, the orality was perfect, and diet was diversified with pieces. Use a pleural flap to bury or isolate sutures is well known technic.2 But use only pleura to replace the esophageal wall is not described. Partial reconstruction of a hemiesophageal wall with only pleura is possible, despite difficult conditions. It is a trick easily achievable in case of difficulty, with a good result that is maintained over time.

Post-operative outcomes of different surgical approaches to oropharyngeal squamous cell cancer: a case-matched study

2021 ◽  
pp. 1-7
Author(s):  
G Tirelli ◽  
A Bertolin ◽  
F Guida ◽  
S Zucchini ◽  
M Tofanelli ◽  
...  
Keyword(s):  
Oropharyngeal Cancer ◽  
Cell Cancer ◽  
Oral Feeding ◽  
Surgical Approaches ◽  
Transoral Laser Microsurgery ◽  
Laser Microsurgery ◽  
Cancer Management ◽  
Lateral Pharyngotomy ◽  
Operative Outcomes ◽  
Duration Of Surgery

Abstract Objective To compare the post-operative outcomes of transoral laser microsurgery, lateral pharyngotomy and transmandibular surgery in oropharyngeal cancer management. Methods Records of 162 patients treated with transmandibular surgery, transoral laser microsurgery or lateral pharyngotomy were reviewed. The transoral laser microsurgery cohort was matched with the lateral pharyngotomy and transmandibular surgery cohorts for tumour stage, tumour subsite and human papilloma virus status, and the intra- and post-operative outcomes were compared. Results Duration of surgery and hospital stay were significantly longer for transmandibular surgery. Tracheostomy and nasogastric feeding tube rates were similar, but time to decannulation and to oral feeding were longer in the transmandibular surgery group. Transmandibular surgery more frequently required flap reconstruction and had a greater complication rate. Negative margins were fewer in the lateral pharyngotomy group than in the transoral laser microsurgery and transmandibular surgery groups. Conclusion In comparison with transmandibular surgery, transoral laser microsurgery and lateral pharyngotomy were associated with fewer complications and faster functional recovery. Lateral pharyngotomy had a higher rate of positive margins than transoral laser microsurgery, with a consequently greater need for adjuvant therapy. Many patients are nonetheless unsuitable for transoral surgery. All these factors should be considered when deciding on oropharyngeal cancer surgical treatment.

Surgical reconstruction of pilonidal sinus disease with concomitant extracellular matrix graft placement: a case series

2021 ◽  
Vol 30 (Sup7) ◽  
pp. S28-S34
Author(s):  
Abigail E Chaffin ◽  
Shane G Dowling ◽  
Mychajlo S Kosyk ◽  
Brandon A Bosque
Keyword(s):  
Extracellular Matrix ◽  
Postoperative Complications ◽  
Pilonidal Sinus ◽  
Case Series ◽  
Surgical Reconstruction ◽  
Pilonidal Sinus Disease ◽  
Surgical Approaches ◽  
Flap Reconstruction ◽  
Recurrence Rates ◽  
Sinus Disease

Background: Pilonidal sinus disease (PSD) is a chronic inflammatory disease affecting the soft tissue of the sacrococcygeal region and remains a challenging disease for clinicians to treat. The optimal treatment for PSD remains controversial and recent reports describe several different surgical approaches offering different benefits. Approximately 40% of initial incision and drainage cases require subsequent surgery. Due to high recurrence rates and postoperative complications, a more complex revision surgery involving a flap reconstruction may be required. We hypothesised that the combination of an extracellular matrix (ECM) graft with tissue flap reconstruction may decrease the postoperative complications and recurrence rates for PSD. Method: We report a retrospective case series using a surgical flap reconstruction with concomitant implantation of an ovine forestomach ECM graft under a fasciocutaneous flap with an off-midline closure for recurrent PSD, where previously surgical intervention had failed due to wound dehiscence and/or recurrent disease. Results: The case series included six patients. After three weeks, all patients except one were fully healed, and the sixth was fully healed by week 4; all wounds remained fully healed at 12 weeks. All patients achieved good cosmesis and were able to return to normal function without any residual symptoms. Conclusion: This pilot case series explored augmenting a flap reconstruction for complex PSD with advanced ECM graft materials, demonstrating that it may improve outcomes and minimise typical complications seen in flap closure, such as inflammation, infection, haematoma/seroma and hypoperfusion. Although the study had a limited number of participants, long-term outcomes were promising and suggest that further studies are warranted.

scholarly journals Is it safe to move away from a full sternotomy for aortic valve replacement?

2020 ◽  
Vol 28 (9) ◽  
pp. 553-559
Author(s):  
Ayman Kenawy ◽  
Abdelrahman Abdelbar ◽  
Charlene Tennyson ◽  
Rebecca Taylor ◽  
Joseph Zacharias
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Median Sternotomy ◽  
Statistical Testing ◽  
Categorical Variables ◽  
Surgical Approaches ◽  
Continuous Variables ◽  
Surgical Aortic Valve Replacement ◽  
Right Thoracotomy

Background Minimally invasive surgical approaches have gained popularity among patients and surgeons. The aim of this project was to assess the safety of initiating aortic valve replacement via an anterior right thoracotomy program. Methods Between May 2015 and May 2019, data of all isolated primary aortic valve replacements were extracted retrospectively from our prospectively collected database and categorized into conventional median sternotomy, hemisternotomy, and anterior right thoracotomy cases. In total, 661 patients underwent isolated primary aortic valve replacement, of whom 429 (65%) had a median sternotomy, 126 (19%) had a hemisternotomy, and 106 (16%) had an anterior right thoracotomy. Preoperative characteristics were similar in each of the three groups. Statistical testing of the surgical groups was undertaken using the chi-square test for categorical variables and one-way analysis of variance with Tukey post-hoc pairwise tests (where appropriate) for continuous variables, to identify differences between pairs of data. Results Cardiopulmonary bypass and crossclamp times were significantly longer in the anterior right thoracotomy group compared to the hemisternotomy and median sternotomy groups ( p < 0.001). Blood loss was significantly less and hospital stay significantly shorter in the hemisternotomy group compared to median sternotomy group but not the anterior right thoracotomy group. Mortality, stroke, renal, gastrointestinal and respiratory complications showed no statistical differences. Conclusion Surgical aortic valve replacement had a very low mortality and morbidity in our experience, and it is safe to start a minimal access program for aortic valve replacement.

Is Hyperamylasemia after Cardiac Surgery Due to Cardiopulmonary Bypass?

2002 ◽  
Vol 10 (2) ◽  
pp. 115-118 ◽  
Author(s):  
Song Wan ◽  
Ahmed A Arifi ◽  
Carmen SY Chan ◽  
Calvin SH Ng ◽  
Innes YP Wan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Median Sternotomy ◽  
Serum Levels ◽  
Surgical Approaches ◽  
Clear Correlation ◽  
Off Pump ◽  
Surgical Access

Although hyperamylasemia has been reported in a large proportion of patients undergoing cardiac surgery with cardiopulmonary bypass, its clinical significance and pathogenetic mechanisms remain poorly understood. The study was designed to investigate whether avoidance of cardiopulmonary bypass would limit amylase elevation. Serum levels of amylase and lipase were measured preoperatively as well as 24 and 48 hours postoperatively in 58 patients undergoing elective coronary artery bypass grafting. Three surgical approaches were used: cardiopulmonary bypass (n = 32) and off-pump through a median sternotomy (n = 14) or a left minithoracotomy (n = 12). There was no hospital mortality or postoperative abdominal complications. Transient hyperamylasemia occurred in 14 patients: 7 (22%), 5 (36%), and 2 (17%) in the respective groups. The increase in amylase levels was similar among the groups. However, no lipase elevation was detected in any patient. There was no clear correlation between hyperamylasemia and increased creatinine levels. Perioperative plasma calcium levels were normal in patients who had hyperamylasemia. Our results indicate that hyperamylasemia after bypass surgery is not related to the use of cardiopulmonary bypass or the mode of surgical access.

Surgical resection of large anterior mediastinal masses: Results of median sternotomy approach.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20005-e20005
Author(s):  
Raj Mohan
Keyword(s):  
Superior Vena ◽  
Germ Cell Tumors ◽  
Median Sternotomy ◽  
Vena Cava ◽  
Postoperative Mortality ◽  
Surgical Approaches ◽  
Femoral Access ◽  
Ct Guided ◽  
Mediastinal Masses ◽  
Cardiac Bypass

e20005 Background: Anterior mediastinal masses are a diverse group of tumors generally presenting as compressive symptoms. Larger masses require open surgical approaches including median sternotomy or sterno-thoracotomy. In this study we analyzed the surgical and pathological outcomes of large anterior mediastinal masses resected through sternotomy approach. Methods: Data of 16 patients with anterior mediastinal masses ( > 10 cms) treated surgically was analyzed retrospectively. All the patients were evaluated preoperatively with MRI, CT guided biopsy and pulmonary function test followed by exploration through median sternotomy approach with/without cardiac bypass (through femoral access). Adjuvant chemo-radiation was used according to histopathological features. Results: A total of 10 male and 6 females with median age 42 years (range: 6-62) underwent resection. Three patients received neoadjuvant chemotherapy and the mean tumor size was 12.2 cms. Histopathologies included mature teratomas/dermoids (4), thymic carcinoma (3), nerve sheath tumors (3), malignant germ cell tumors (3), synovial sarcoma (1) primary mediastinal goiter (1) and inflammatory pseudo tumor (1). There was no postoperative mortality and two patients required cardiac bypass. Bovine pericardium was used in two patients for the loss of large are of pericardium. One patient required biograft for replacement of resected superior vena cava. Major morbidities included prolonged ventilation and intrathoracic collection in two patients. All the patients were disease free after a median follow up of 14 months. Conclusions: Large anterior mediastinal masses are challenging surgically. An aggressive surgical approach through median sternotomy in association with cardiac bypass helps in complete resection and may lead to optimal results.

Robot-Assisted Mitral Valve Repair a Single Institution Review

2010 ◽  
Vol 5 (4) ◽  
pp. 295-299 ◽  
Author(s):  
Castigliano M. Bhamidipati ◽  
Gaurav S. Mehta ◽  
Muhammad F. Sarwar ◽  
Renganaden Sooppan ◽  
Karikehalli A. Dilip ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Median Sternotomy ◽  
Secondary Outcome ◽  
Surgical Approaches ◽  
Team Approach ◽  
Valve Repair ◽  
Single Institution ◽  
Definitive Therapy

Objective Mitral valve repair (MVR) is the definitive therapy for mitral myxomatous degeneration. Median sternotomy has been the traditional approach to repair until the advent of the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA). Minimally invasive surgical approaches for mitral repair have been slow to gain acceptance in cardiac surgery. We review the MVR results from our single-institution academic robotic program. Methods From August 2004 through April 2008, patients who underwent a robotic-assisted (RA) MVR were identified. RA technique included a 4-cm right minithoracotomy, femoral cardiopulmonary bypass with transthoracic aortic occlusion, and RA-MVR. Repair types were combinations of quadrangular/triangular leaflet resection, sliding plasty, chordal transfer/replacement, and edge-to-edge approximation, with band annuloplasty in all cases. Postrepair echocardiography and morbidity follow-ups were completed in all patients. Our primary outcome was adequacy of repair, and secondary outcome was major complications. Results There were 43 patients (29 male and 14 female) who underwent RA-MVR for severe (4 +) mitral regurgitation during the 4-year review. Average operative time was 272.26 minutes. Only one patient had mild postoperative mitral regurgitation, whereas 20 had trace and 22 had no regurgitation after repair. Mean ventilator time was 32.1 hours, and length of stay was 5.7 days. One third of the patients (33%) received postoperative-packed red blood cell transfusions (average: 2.4 units per patient). Twenty-eight percent of patients developed atrial fibrillation after repair. Most of the patients (95.3%) were discharged home. There were no 30-day mortalities. Conclusions Based on our small single-institution experience, RA-MVR provides an effective treatment for severe mitral valve regurgitation. Although procedure durability is slowly being established, preliminary results are promising. Careful programmatic advances with an integrated team approach can facilitate acceptable postoperative outcomes and excellent MVR.

Surgical reconstruction of central venous obstruction in salvaging upper extremity dialysis accesses

2017 ◽  
Vol 18 (4) ◽  
pp. e39-e41 ◽  
Author(s):  
Jurabek Babadjanov ◽  
Rick Bernstein ◽  
Lee Kirksey
Keyword(s):  
Median Sternotomy ◽  
Symptomatic Patient ◽  
Surgical Reconstruction ◽  
Central Vein ◽  
Intermittent Hemodialysis ◽  
Central Venous ◽  
Venous Bypass ◽  
Central Vein Occlusion ◽  
Vein Occlusion ◽  
Arm Swelling

Background Central vein thrombosis or obstruction is a common complication associated with central venous catheters placed for intermittent hemodialysis. The reported outcomes of percutaneous catheter-based interventions reveal high rates of lesion recurrence with varying and frequently limited patency intervals. We present the case of open venous bypass in the treatment of catheter-associated chronic central vein occlusion. Methods We report a case of symptomatic arm swelling secondary to central vein stenosis and failed endovascular venous intervention treated by central vein bypass with prosthetic graft through median sternotomy. Results Patient had an open axillary to innominate venous bypass via median sternotomy incision, which resulted in resolution of patient's symptoms and uninterrupted patency of the pre-existing vascular access. Conclusions Open venous bypass is a reliable alternative to endovascular intervention in the symptomatic patient with extensive central vein occlusion as a primary intervention or in whom prior endovascular therapy has failed.

Management of Esophageal Lung in a Patient With VACTERL Anomalies

2020 ◽  
Vol 86 (11) ◽  
pp. 1538-1540
Author(s):  
Kevin N. Harrell ◽  
Jonathan Brent Moss ◽  
Syamal Dave Bhattacharya ◽  
Curtis S. Koontz
Keyword(s):  
Main Bronchus ◽  
Rare Type ◽  
Renal Anomalies ◽  
Esophageal Bronchus ◽  
Rare Congenital Abnormality ◽  
Lobar Bronchus ◽  
Foregut Malformation ◽  
Long Gap Esophageal Atresia ◽  
Staged Reconstruction ◽  
Tomography Scan

Esophageal lung is a rare type of bronchopulmonary foregut malformation where an anomalous main bronchus arises from the esophagus rather than the trachea. This differentiates from an esophageal bronchus where a lobar bronchus arises from the esophagus. Fewer than 30 of these anomalies have been reported in the literature. A female infant was born at 35 weeks gestational age and found to have multiple congenital abnormalities including cleft palate, long-gap esophageal atresia, tracheoesophageal fistula (TEF), imperforate anus, and renal anomalies. She initially underwent thoracoscopic ligation of TEF with colostomy and mucus fistula creation. Bronchoscopy found no right mainstem bronchus, and subsequent computed tomography scan was consistent with possible esophageal bronchus. Esophagoscopy through the gastrostomy discovered a fistulous connection between the distal esophagus and anomalous main right bronchus. Right thoracotomy with pneumonectomy of the hypoplastic lung was performed. She subsequently underwent vaginostomy for hydrometrocolpos. Her proximal esophagus was diverted with a cervical esophagostomy for control of secretions. She also required tracheotomy and is currently at home on minimal ventilator settings awaiting staged reconstruction. Esophageal lung is a rare congenital abnormality with few reported cases. Surgical treatment with pneumonectomy is often required, and pediatric surgeons should be familiar with these congenital bronchopulmonary malformations.

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