Posterior Tracheopexy (PT) for Tracheomalacia | Genova, Italy | May 2019 - Nov 2022 | Prospective Observational Study | RESULTS: | 12 Patients | with symptomatic tracheobronchomalacia | MEDIAN AGE: 12 Years | Patients underwent | thoracoscopic PT (n = 3) | robot-assisted thoracoscopic PT (n = 9) | POSTERIOR TRACHEOPEXY: | 75% Improved or resolved symptoms | IMAGING: | Thoracic CT scans, bronchoscopies & esophagrams | POST-OP COMPLICATIONS: | 25% 2/3 related to the esophagus | PT is a useful & safe procedure for tracheobronchomalacia tx. | CONCLUSIONS: Esophagus mobilization may play a role in post-op complications. | Post-op esophagogram measurements may predict PT outcomes. | https://doi.org/10.1055/a-2111-5605 | Source: Torre, M et.al. | Department of Pediatric Surgery & Neonatal Surgical Thoracic and Airway Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy | @StayCurrentMD | @ccolunga | Cincinnati Children's | EJPS
Posterior Tracheopexy for Tracheomalacia: A Study of Clinical and Radiological Consequences on Esophagus
Infographic · Sep 2023 · 1 min read
In brief
In brief
Study of 12 patients undergoing posterior tracheopexy for severe tracheomalacia demonstrates consistent rightward esophageal displacement (median 27.5mm) postoperatively. Most patients remained asymptomatic, though one esophageal perforation and one case of transient dysphagia occurred, highlighting the need for cautious esophageal mobilization, especially in patients with prior thoracic procedures.
- Posterior tracheopexy consistently causes rightward esophageal displacement (median 27.5mm), measurable on postoperative esophagogram.
- Most patients tolerate esophageal dislocation without dysphagia; severe displacement may cause transient swallowing difficulty.
- Esophageal perforation risk is elevated in patients with prior thoracic surgery (e.g., EA repair); mobilize esophagus cautiously.
- Robot-assisted thoracoscopic approach is feasible for posterior tracheopexy (9/12 cases in this series).
- Pre- and postoperative esophagography documents anatomic changes and guides management of postoperative dysphagia.
Written by the GCMD Library team from the infographic.
A teal-colored infographic divided into left and right sections with white icons including a location pin, calendar, magnifying glass, patient figure, birthday cake, lungs diagram, and surgeon illustration. Yellow banner at bottom contains conclusions. Header displays procedure name in white text.
New infographic by Dr. Carlos Colunga
"Posterior Tracheopexy for Tracheomalacia: A Study of Clinical and Radiological Consequences on Esophagus"
Authors: Torre M, Reali S, Rizzo F, Guerriero V, Palo F, Arrigo S, Sacco O,Mattioli G
Full article: https://doi.org/10.1055/a-2111-5605
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.