Comparative Study of Early Postoperative Complications: Thoracic Anastomosis vs Cervical Anastomosis - in Esophageal Replacement with Gastric Graft.

Gastric pull-up is the most commonly used procedure for esophageal replacement in both malignant and benign conditions. In our article we compare the differences in mortality and morbidity between thoracic anastomosis and cervical anastomosis during gastric pull-up. The study group comprised of 126 patients - 58 patients (56%) with cervical anastomosis and 68 patients (64%) with thoracic anastomosis. The overall mortality in the study group was 5.55% (7 patients), while the overall morbidity was higher at 28%. There were no significant differences between the two subgroups regarding mortality and morbidity, although the rate of anastomotic leakage was higher in the cervical subgroup (13.8% vs 1.5%). We recommend performing thoracic anastomosis during gastric pull-up whenever the location of the lesion allows it, since the procedure is safe, relatively easy to master and it shortens operating time by excluding the cervical approach.

Postintubation Tracheoesophageal Fistula - Diagnosis, Treatment and Prognosis.

Introduction: Postintubation tracheoesophageal fistula is a severe complication occurring under certain conditions in patients that require prolonged mechanical ventilation. MATERIAL AND METHODS: This article focuses on a sample of 11 patients with postintubation tracheoesophageal fistula, operated in our department between 2005 and 2015. The anterior approach with tracheal resection was performed in 10 of these patients, while an atypical surgical technique was preferred in a case involving a large-sized fistula. Three of these patients were subject to surgery while still on the ventilator, in order to help weaning them from mechanical ventilation. Two patients were operated following a relapse of the fistula, after attempts of closing it in other surgical units. Results: Two patients (of those who were still on mechanical ventilation) died from intubation-related complications that persisted after tracheal resection (anastomotic dehiscence with mediastinitis and tracheoarterial fistula in the brachiocephalic arterial trunk). The nine remaining patients improved, with their airways restored and having regained normal deglutition. Conclusions: The surgical approach of this pathology is successful in surgical units that are specialised in tracheal and oesophageal surgery. Adequately timing the surgery is crucial for a good outcome.

Acquired benign tracheo­oesophageal fistula secondary to oesophageal stenting for post lye ingestion stenosis: A case report.

Acquired benign trachea-oesophageal fistula is a rare benign pathological entity with varying aetiologies that most often occurs post-intubation. This case report presents the case of a female patient, 31 years old, admitted to the emergency room with sepsis syndrome following bilateral aspiration pneumonia caused by a large trachea-oesophageal fistula. The fistula was the result of intra-tracheal migration of an oesophageal stent placed for post lye ingestion stenosis. Esophageal diversion and partial resection with oesophageal patch to repair the tracheal defect, under general anaesthesia with ventilation using rigid bronchoscopy and high frequency jet ventilation (HFJV), followed at a later date by esophageal replacement with colic graft were the procedures performed with a view to curing the patient. In conclusion, complex cases always require a tailored approach. It is important to note that HFJV may be applied for a longer period of time and the oesophagus can be used as patch for the posterior tracheal wall in selected cases. Staged surgery is also an option when the patients' poor health status does not permit major surgery.

[Iatrogenic tracheal stenosis in patients with COPD: a medico-surgical challenge]. / Stenoza traheala iatrogena la pacientul cu BPOC: o provocare medico-chirurgicala.

This study analyzes a series of iatrogenic tracheal stenosis occurring in patients with COPD exacerbation which required oro-tracheal intubation. The tracheal stenosis occurred on average after 24 days of intubation and were clinically severe. Treatment algorithm first included bronchoscopic interventional techniques with an immediate success rate of 37%, but the results were unstable in time, requiring tracheal stenting. The surgical approach, which generally is the first choice in the treatment of tracheal stenosis, had discouraging results in these patients, with a low rate of success (20%) and an increased incidence of restenosis. The only solution for those postoperative complications was, again, interventional bronchoscopy. In conclusion, while for various other etiologies of tracheal stenosis the surgical resection is the first choice of treatment, in COPD patients interventional bronchoscopy often remains the only way of solving.

[Remediastinoscopy--current indications. A case report]. / Remediastinoscopia--indicatii actuale. Prezentare de caz.

Current indications for remediastinoscopy include an inadequate first procedure, recurrent and second primary lung cancer, lung cancer occurring after an unrelated disease such as lymphoma, and restaging after induction therapy. Nowadays, restaging is the most frequent indication for remediastinoscopy. We present the case of a 42 years old male with a mediastinoscopy performed in another surgical unit 4 months before being admitted in our department. The CT scan showed bulky mediastinal lymph node enlargement, in evolution compared with the prior one, and no other lesions in the lung parenchyma. As the histopathological examination from the first specimen was negative, a diagnosis was requested in order to allow a correct treatment. A remediastinoscopy was successfully performed and avoided a more invasive procedure.

[Tracheal stenosis--diagnostic and therapeutic principles, results]. / Stenozele traheale--principii de diagnostic si tratament, rezultate.

Between November 2001-April 2010, 107 tracheal resections were performed in our department for different types of tracheal stenosis: iatrogenic or tumoral, benign or malignant. We present the diagnosis and treatment principles that we used, along with our results. We operated on 74 (69.15%) iatrogenic postintubation tracheal stenosis, 6 (5.6%) of them complicated with tracheo-esophageal fistula, 6 (5.6%) benign tumors, 11 (10.28%) primary malignant and 16 (14.97%) secondary malignant ones, with a 3.8% total mortality. Tracheal resection and reconstruction is the only curative treatment for all types of tracheal stenosis. Interventional endoscopy is of a major importance in the assessment and treatment of tracheal stenosis. We believe that each patient diagnosed with a tracheal stenosis should be referred to a tertiary center with multidisciplinary experience in the treatment of tracheal stenosis.

[Preoperative evaluation for pulmonary resections in COPD patients]. / Evaluarea preoperatorie a pacientilor cu BPOC în vederea interventiilor chirurgicale toracice de rezectie pulmonara.

Chronic obstructive pulmonary disease - COPD, being one of the most frequent chronic pathologies in the world, an important number of such patients can necessitate, at a certain moment, a thoracic surgical intervention, especially pulmonary resections for pulmonary carcinoma. In these cases, the removing of a certain volume of pulmonary tissue from a patient who already has a respiratory malfunction necessitates a judicious preoperative evaluation to establish the correct indication, risk factors and postoperative prognosis (at least regarding the pulmonary function). Although the preoperative evaluation for pulmonary resections has been studied for many years, a parameter has not been found yet, simple or combined, to accurately predict the outcome. The majority of the candidates for pulmonary resections can be operated without previous complicated tests like CPET (cardio-pulmonary exercise testing) and regional pulmonary function, which are expensive and sometimes non accessible. In the past years, CPET gained more and more field in the appreciation of the surgical risk; combined with the split measurement of the function of the two lungs, it can even predict the postoperative effort capacity. In the complex preoperative evaluation of the chronic pulmonary patients we must not forget other, not so obvious aspects, so that the patient could benefit by the optimum moment and health status for his or her operation, for the purpose of a better prognosis.

[Metachronous bronchial carcinoma--three years after right upper lobectomy. A case report]. / Carcinom pulmonar drept metacron--trei ani dupa lobectomie superioara dreapta. Prezentare de caz.

The emergence of a secondary pulmonary neoplasm at some time after the primary one raises diagnostic and therapeutic issues especially in patients with functional respiratory capacities at the limits of resectability. We present the case of a 53 years old patient which suffered a right upper lobectomy three years before for a moderately differentiated squamous carcinoma and in which a second cancer was discovered in the right main bronchus. Para-clinic explorations demonstrated the lack of local and systemic invasion of the second cancer. The optimal therapeutic way is presented and its result, discussing also the means for long term follow-up of the patients operated for non-small cell lung cancer.