Intraoperative Accidents and Complications in the Surgery of the Esophagus

Abstract

The esophagus is anatomically surrounded by important mediastinal organs, such as tracheobronchial airway, cardiovascular, nerve, and lymphatic systems. Although intraoperative injuries during esophagectomy are relatively rare, they cause serious and life-threatening conditions. Prevention is the most reliable way to avoid intraoperative accidents. Preoperative evaluation of surgical anatomies of the mediastinal organs and precise surgical procedures are recommended. Surgeons must always consider the countermeasures for emergencies prior to esophagectomy. Once such horrible accidents and complications occur, surgeons are required to be calm and to recover the injuries by appropriate procedures. When the tracheobronchial injury is recognized, endotracheal tube should be advanced beyond the injury point to control the airway, and then primary closure and/or appropriate patch or flap using vital organs should be performed. Intraoperative major bleeding should first be controlled by pressure, next surgeons should communicate with surgical team and operation staff about the situation and countermeasures, and then, if needed, request the support of cardiovascular surgeons.