Abstract
A survivor, following successful repair of laryngotracheo-esophageal cleft extending
up to cervical trachea, is being described. The cleft was repaired with anterior laryngofissure
approach, using no interposition of tissue between trachea and esophagus. The patient
had an uneventful recovery, short hospitalization, and satisfactory outcome on follow-up
for over 11/2 years, as of now. Optimum ventilation was achieved intra-operatively
via an endotracheal tube passed through operative field, following visualization of
the cleft. Postoperatively, mechanical ventilation was given via nasotracheal tube
left indwelling in trachea following completion of tracheal repair. Early nutrition
through enteral route was started 72 hours postoperatively by drip feeds (using infusion
pump) through a soft nasogastric tube that was left indwelling following esophageal
repair. This maneuver, along with positional and medical therapy, helped us to gain
control over gastro-esophageal reflux that is known to be incapacitating in these
patients. The authors recommend a reexamination of existing management strategies
for patients with laryngotracheo-esophageal clefts and suggest that conservative approach
in dealing with associated problems can help decrease morbidity in these patients.
Keywords
Laryngotracheo-esophageal cleft - survivor - ventilation - gastro-esophageal reflux
