[Use of greater omentum for arrosive hemorrhage in tracheal surgery]

[Improving surgical technique for tracheal resection with anastomosis]

OBJECTIVE

To present modern aspects of improving surgical techniques in tracheal resection developed in recent years.

MATERIAL AND METHODS

The authors have the most extensive experience in tracheal surgery (>2.000 patients over the past 50 years). Diagnostic capabilities, perioperative management and surgical techniques have changed over such a long period. This concerns the proposed classification of cicatricial tracheal stenosis, features of endoscopic and X-ray diagnostics, indications for various surgeries, choice of surgical approach, technique of tracheal tube mobilization and anastomosis after tracheal excision. Preventive measures for severe postoperative complications are described.

CONCLUSION

Such an extensive experience allowed the authors to develop an algorithm for the treatment of patients with tracheal stenosis. This significantly reduced the incidence of postoperative complications and mortality. Replication of such equipment is associated with technical support of hospitals and professional level of specialists consisting of endoscopist, anesthesiologist, intensive care specialist and thoracic surgeon.

[Surgical management of tracheal anastomosis failure and risk of arterial bleeding]

OBJECTIVE

To determine the optimal algorithm for tracheal anastomotic insufficiency and prevention of arterial bleeding.

MATERIAL AND METHODS

We present 2 patients with defects of tracheal anastomosis after tracheal resection and divergence of tracheal edges. We primarily analyzed appropriate emergency care and prevention of subsequent severe complications such as arterial bleeding and respiratory insufficiency.

CONCLUSION

Tracheostomy may be preferable for complete late tracheal anastomotic insufficiency to restore breathing. However, surgery should be accompanied by prevention of arterial bleeding. Isolation of damaged area, particularly tracheostomy tube, from the mediastinum by well-vascularized tissues can prevent bleeding from major vessels (for example, innominate artery). Follow-up is unreasonable due to worsening of clinical situation, risk of hemorrhagic complications and fatal outcomes. General satisfactory clinical status of the patient is not of matter. Repeated tracheal anastomosis is justified only for early insufficiency, i.e. within 2-3 days when postoperative inflammation is mild.

IS A BIG OMENTUM THE SURGEON'S BEST FRIEND OR WORST ENEMY? REVIEW

The interest of surgeons in the greater omentum is associated with a unique combination of such functions as plasticity, immune defense, barrier, hormonal, angiogenesis and regeneration for adjacent tissues, reabsorption, hemostatic, thermoregulation. The purpose of this review was to track the historically changing position of operations with the use of the greater omentum in abdominal, thoracic surgery, reconstructive plastic surgery, analyze the aspects of the use and controversial issues of omentization of the anastomoses line and omentoplasty in modern conditions, as well as highlight promising directions for the use of the greater omentum in medicine. in the sources of domestic and foreign databases until July 2021. Information about the negative consequences of omentectomy is given – a decrease in local and general immunoresistance, the development of adhesive disease, an increase in the number of postoperative purulent-inflammatory complications. It is useful for the surgeon to use a large omentum in non-standard and technically difficult cases. Situations are described in which a radical attitude to the greater omentum is justified – torsion of the omentum strand, metastasis, adhesions, omentitis, entrapment in hernias, complications from the pedicle flap. Analysis of the literature revealed ambiguous results of omentization and omentoplasty, which indicates the need for randomized studies in this area, the development of clinical recommendations for these operations with a description of clear indications and methods of carrying out. 

[Etiology, diagnosis and treatment of cicatricial tracheal stenosis]

Development of tracheal surgery was associated with introduction of fundamentally new procedures: two-level reconstruction, redo tracheal resection, tracheal resection with simultaneous dissection of tracheoesophageal fistula. There are combined and staged techniques when tracheal repair or endoscopic interventions are performed as a stage before circular resection of trachea. However, a single algorithm for prevention and correction of postoperative complications is still absent in tracheal surgery. Further development of tracheal surgery directly depends on introduction of preventive measures and analysis of adverse factors associated with increased risk of complications. In this regard, ongoing researches in this area are very perspective.