Abstract
Anastomotic complications of tracheo-bronchoplasty often lead to critical postoperative conditions and deteriorated QOL. Operative approaches, tension-reducing techniques and wrapping procedures for improvement of anastomotic circulation depend on the localization and range of the involved lesions. In this study, intrathoracic tracheal reconstructions were evaluated from the viewpoint of complications in 36 cases: 11 middle and lower tracheal resections, 12 right pneumonectomies (RP), 6 left pneumonectomies (LP), and 7 right upper lobectomies (RUL) with carinal resection.
The results were as follows: (1) Postero-lateral thoracotomy is a standard approach for RP and RUL, except for the cases requiring a combined resection of the SVC. For RUL cases with carinal reconstruction, release techniques and wrappings are essential because of frequent anastomotic complications. (2) An operative approach for LP hasn't been established so far. However, clamshell incision and reconstructions under ECMO have provided better visibilities in certain anastomoses. (3) Median sternotomy with a collar incision is convenient for middle and lower tracheal reconstructions because of its availability for immediate release techniques and wrappings.
