TY - JOUR
T1 - Tracheal Reconstruction by Esophageal Submuscular Tunneling
T2 - An Experimental Study
AU - Hodjati, Hossein
AU - Kazemi, Kourosh
AU - Jalaeian, Hamed
AU - Reza Sharifzad, Hamid
AU - Roshan, Naghmeh
AU - Tanideh, Nader
PY - 2008/11
Y1 - 2008/11
N2 - Background: The problem of how to treat large tracheal lesions remains a challenge in surgery. To reconstruct a long tracheal defect, a safe method other than end-to-end anastomosis is necessary. Materials and methods: In 14 adult cross-breed dogs, a segment of trachea including seven tracheal rings was dissected and resected circumferentially. A submuscular tunnel was induced between mucosal and muscular layers of the adjacent esophagus lying right next to the trachea. An endotracheal tube was inserted between the tracheal rings 2 and 3. Then it was passed cautiously through the esophageal submuscular tunnel and through the distal tracheal segment. The proximal and distal ends of the esophageal tunnel and trachea were approximated and anastamosed. The animals were extubated 10 days after the operation. Results: All dogs tolerated the surgical procedure well. The first two dogs experienced postoperative fever, tracheoesophageal fistula, aspiration pneumonia, and sepsis so hard bony components were omitted from diet. All survived animals were eating and barking well. The submuscular esophageal tunnel was patent in all animals. The new lumen was supported externally with fibrous connective tissue. The tunnelized area was covered completely with pseudostratified ciliated epithelium. Conclusion: Due to formation of fibrous tissue between skeletal muscular structures of the neck and the external layer of the tunnelized esophagus, the new airway remained patent. Overall, air tightness, good reepithelialization, and relatively no limitation of esophageal length are the advantages of tracheal reconstruction by submuscular esophageal tunneling. This new method is worthy of further investigation, as it is technically feasible and easy to implement.
AB - Background: The problem of how to treat large tracheal lesions remains a challenge in surgery. To reconstruct a long tracheal defect, a safe method other than end-to-end anastomosis is necessary. Materials and methods: In 14 adult cross-breed dogs, a segment of trachea including seven tracheal rings was dissected and resected circumferentially. A submuscular tunnel was induced between mucosal and muscular layers of the adjacent esophagus lying right next to the trachea. An endotracheal tube was inserted between the tracheal rings 2 and 3. Then it was passed cautiously through the esophageal submuscular tunnel and through the distal tracheal segment. The proximal and distal ends of the esophageal tunnel and trachea were approximated and anastamosed. The animals were extubated 10 days after the operation. Results: All dogs tolerated the surgical procedure well. The first two dogs experienced postoperative fever, tracheoesophageal fistula, aspiration pneumonia, and sepsis so hard bony components were omitted from diet. All survived animals were eating and barking well. The submuscular esophageal tunnel was patent in all animals. The new lumen was supported externally with fibrous connective tissue. The tunnelized area was covered completely with pseudostratified ciliated epithelium. Conclusion: Due to formation of fibrous tissue between skeletal muscular structures of the neck and the external layer of the tunnelized esophagus, the new airway remained patent. Overall, air tightness, good reepithelialization, and relatively no limitation of esophageal length are the advantages of tracheal reconstruction by submuscular esophageal tunneling. This new method is worthy of further investigation, as it is technically feasible and easy to implement.
KW - esophageal tunneling
KW - experimental surgery
KW - tracheal reconstruction
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U2 - 10.1016/j.jss.2007.12.778
DO - 10.1016/j.jss.2007.12.778
M3 - Article
C2 - 18316095
AN - SCOPUS:53249115609
VL - 150
SP - 74
EP - 77
JO - Journal of Surgical Research
JF - Journal of Surgical Research
SN - 0022-4804
IS - 1
ER -