Analysis of respiratory complications after minimally invasive esophagectomy: preliminary observation of persistent aspiration risk

Minimally invasive (MI) esophageal resection (ER) has the theoretical advantage of reduced postoperative complications compared with standard ER. However, the impact of MIER on rates and severity of pulmonary complications is unclear. Four patients underwent laparoscopic gastroesophageal mobilizatio...

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Bibliographic Details
Published in:Dysphagia 2007-01, Vol.22 (1), p.49-54
Main Authors: Atkins, B Zane, Fortes, Daniel L, Watkins, Kevin T
Format: Article
Language:English
Subjects:
Deglutition
Deglutition Disorders - etiology
Esophagectomy - adverse effects
Esophagus - injuries
Humans
Minimally Invasive Surgical Procedures - adverse effects
Pneumonia, Aspiration - etiology
Postoperative Complications
Respiration
Respiratory Tract Diseases - etiology
Risk Factors
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Summary:Minimally invasive (MI) esophageal resection (ER) has the theoretical advantage of reduced postoperative complications compared with standard ER. However, the impact of MIER on rates and severity of pulmonary complications is unclear. Four patients underwent laparoscopic gastroesophageal mobilization and resection followed by gastric pull-up and cervical esophageal anastomosis (MIER). Videofluoroscopic swallowing studies (VFSS) assessed pharyngolaryngeal function postoperatively. All postoperative complications were documented. Each MIER was completed successfully without intraoperative complications. Mean operative time was 4.3 +/- 2 h. Postoperatively, VFSS detected laryngeal penetration, vocal cord paralysis, and/or aspiration in three patients, two of whom experienced severe respiratory complications. MIER patients are susceptible to aspiration, likely due to transient denervation of the pharynx and laryngeal structures. Following MIER, aggressive pulmonary toilet and aspiration precautions are emphasized to reduce pulmonary complications. Furthermore, serial evaluation of deglutition is encouraged to guide the safe and appropriate resumption of oral feeding.
ISSN:0179-051X
1432-0460
DOI:10.1007/s00455-006-9042-7