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Eur J Pediatr Surg 2024; 34(04): 306-313
DOI: 10.1055/a-2111-5605
Original Article

Posterior Tracheopexy for Tracheomalacia: A Study of Clinical and Radiological Consequences on Esophagus

Michele Torre 
1   Department of Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
2   Department of Pediatric Thoracic and Airway Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
,
Serena Reali 
1   Department of Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
3   Department of Pediatric Surgery, UNIGE DiNOGMI, Genova, Liguria, Italy
,
Francesca Rizzo
4   Department of Radiology Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
2   Department of Pediatric Thoracic and Airway Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
,
Vittorio Guerriero
1   Department of Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
2   Department of Pediatric Thoracic and Airway Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
,
Federico Palo
1   Department of Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
,
Serena Arrigo
5   Department of Gastroenterology Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
2   Department of Pediatric Thoracic and Airway Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
,
Oliviero Sacco
6   Department of Pulmonology Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
2   Department of Pediatric Thoracic and Airway Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
,
Girolamo Mattioli
1   Department of Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
3   Department of Pediatric Surgery, UNIGE DiNOGMI, Genova, Liguria, Italy
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Abstract

Introduction Posterior tracheopexy (PT) directly addresses the posterior trachealis membrane intrusion in severe tracheomalacia. During PT, the esophagus is mobilized and membranous trachea is sutured to the prevertebral fascia. Although dysphagia has been reported as a possible complication of PT, in the literature there are no data investigating postoperative esophageal anatomy and digestive symptoms. Our aim was to study clinical and radiological consequences of PT on esophagus.

Methods Patients with symptomatic tracheobronchomalacia scheduled for PT between May 2019 and November 2022 underwent pre- and postoperative esophagogram. For each patient, we analyzed radiological images and measured esophageal deviation providing new radiological parameters.

Results All 12 patients underwent thoracoscopic PT (n = 3) or robot-assisted thoracoscopic PT (n = 9). For all patients, the postoperative esophagogram showed a right dislocation of the thoracic esophagus (median postoperative deviation = 27.5 mm). We report an esophageal perforation at postoperative day 7 in a patient affected by esophageal atresia, who underwent several surgical procedures before. A stent was placed and esophagus healed. Another patient with severe right dislocation referred transient dysphagia to solids, which resolved gradually in the first postoperative year. All the other patients did not present any esophageal symptoms.

Conclusion For the first time, we demonstrate the right dislocation of the esophagus after PT and we propose an objective method to measure it. In most patients, PT is a procedure not affecting esophageal function, but dysphagia can occur if dislocation is important. Esophagus mobilization during PT should be cautious, especially in patients who underwent previous thoracic procedures.

Keywords

tracheomalacia - tracheobronchomalacia - posterior tracheopexy - esophagogram


Publication History

Received: 07 April 2023

Accepted: 14 June 2023

Accepted Manuscript online:
16 June 2023

Article published online:
20 July 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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