Posterior Tracheopexy for Tracheomalacia: Study of Clinical and Radiological Consequences on Esophagus

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 post-operative 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 post-operative esophagogram. For each patient we analyzed radiological images and measured esophageal deviation providing new radiological parameters. Results: All twelve patients were performed thoracoscopically (n=3) or robot-assisted (n=9). For all patients the post-operative esophagogram showed a right dislocation of the thoracic esophagus (median post-operative deviation = 27.5 mm). We report an esophageal perforation at 7th postoperative day 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 post-operative year. All the other patients did not present any esophageal symptoms. Conclusions: 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.