Published: 2019-06-29

Managing iatrogenic tracheal injury during esophagectomy

Niju Pegu, Joydeep Purkayastha, Abhijit Talukdar, Bibhuti Borthakur, Dipjyoti Kalita, Gaurav Das, Srinivas Bannoth, Jitin Yadav, Dwipen Kalita, Pritesh Singh


Iatrogenic tracheal injuries are uncommon, but potentially lethal and associated with significant morbidity. During esophagectomy the proximity of the trachea to esophagus makes it vulnerable to injury. The reported incidence of tracheal injury during esophagectomy ranges between 1-5%. Various methods for repairing tracheal injuries have been described in the literature. Most preferred mode of repair described is the reinforcement of the primary repair with flap cover. Most common autologous flaps used are pericardium, pleura, extra thoracic muscle flaps and intercostal muscle flaps. Other described methods for repairing tracheal injuries are primary repair without buttressing, and buttressing with gatric conduit serosal patch, graft and glue.  In this study we reviewed different methods and outcome of repair described in the literature and our experienced of managing three cases.


Iatrogenic tracheal injury, Esophagectomy, Autologous flap, Gastric conduit

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Hulscher JB, ter Hofstede E, Kloek J, Obertop H, De Haan P, Van Lanschot JJ. Injury to the major airways during subtotal esophagectomy: incidence, management, and sequelae. J Thorac Cardiovasc Surg. 2000;120:1093–6.

Goldstein P. Fatal interstitial and mediastinal emphysema following accidental needle perforations of the trachea during jugular venipuncture. Am J Dis Child. 1949;78:375–83.

Schipper P. Lymph nodes are important. World J Surg. 2009;33:785–6.

Lemaire A, Nikolic I, Petersen T, Haney JC, Toloza EM, Harpole DH, et al. Nine-year single center experience with cervical mediastinoscopy: complications and false negative rate. Ann Thorac Surg. 2006;82:1185–9.

Tezel C, Okur E, Baysungur V. Iatrogenic tracheal rupture during intubation with a double-lumen tube. Thorac Cardiovasc Surg. 2010;58:54–6.

George SV, Samarasam I, Mathew G, Chandran S. Tracheal Injury during esophagectomy-incidence, treatment and outcome. Trop Gastroenterol. 2011;32(4):309-13.

Sippel M, Putensen C, Hirner A, Wolf M. Tracheal rupture after endotracheal intubation: experience with management with 13 cases. Thoracic Cardiovas Surg. 2006;54(1):51-6.

Gitter R, Daniel TM, Kesser BW, Reibel JF, Tribble CG. Membranous Tracheobronchial Injury repaired with gastric serosal patch. Ann Thoracic Surg. 1999;67(4):1159-60

Millikan KW, Pytynia KB. Repair of tracheal defect with Goretex graft during resection of carcinoma of the esophagus. J Surg Oncol. 1997;66:134–7.

Kram HB, Shoemaker WC, Hino ST, Chiang HS, Harley DP, Fleming AW. J Thorac Cardiovasc Surg. 1985;90 (5):771-5.

Bartels HE, Stein HJ, Siewert JR. Tracheobronchial lesions following oesophagectomy: prevalence, predisposing factors and outcome. Br J Surg. 1998;85:403–6.

Celiker V, Baºgül E, Aykut T. Tracheal rupture during esophagectomy. Ulus Travma Acil Cerrahi Derg. 2005;11:157–61.

Orringer MB, Marshall B, Chang AC, Lee J, Pickens A, Lau CL. Two thousand transhiatal esophagectomies: changing trends, lessons learned. Ann Surg. 2007;246:363–72.

Ceylan KC, Kaya SO, Samancilar O, Usluer O, Gursoy S, Ucvet A. Intraoperative management of tracheobronchial rupture after double-lumen tube intubation. Surg Today. 2013;43:757-62.

Borasio P, Ardissone F, Chiampo G. Post-intubation tracheal rupture. A report on ten cases. Eur J Cardiothorac Surg. 1997;12:98-100.

Gupta V, Gupta R, Thingnam SK, Singh RS, Gupta AK, Kuthe S, et al. Major airway injury during esophagectomy: experience at a tertiary care center. J Gastrointest Surg. 2009;13:438–41.

Knauer M, Haid A, Ammann K, Lang A, Offner F, Türtscher M, et al. Complications after oesophagectomy with possible contribution of neoadjuvant therapy including an EGFRantibody to a fatal outcome. World J Surg Oncol 2007;5:114.

Bhat MA, Singh S, Lone, Dar M, Mir. Management of Intra-operative Tracheal Injuries during Trans-hiatal Esophagectomy for Carcinoma Esophagus. Webmed Central. 2012;3:2-5.