Aspiration Following Surgery of the Thoracic Esophagus

Abstract

Aspiration during operation is rare. It occurs mostly by an inadequate tracheal intubation. We had two such cases in the last five years. Removal of aspirated substances from bronchial trees through bronchofiberscope was effective in treatment of such a condition.Aspiration occurs rather frequently following surgery of the thoracic esophagus. Postoperative aspiration was noted in 18 cases (2.4%) among 758 resections of esophageal carcinomas. In general the patients with postoperative aspiration had a tendency to delay peroral food intakes. The patients with excellent postoperative course usually started peroral food intakes on the 11th postoperative day, those with slight aspiration on the 15th postoperative day, those with moderate aspiration on the 20th postoperative day and those with severe aspiration on the 30th postoperative day respectively. Total parenteral or enteral nutrition was indispensable for management of most patients. All cases with severe aspiration and 14% with slight or moderate aspiration developed bronchopneumonia after they had discharged from the hospital. Prophylactic cares should be taken in their home life.Recurrent nerve paralysis is one of causes for postoperative aspiration. Eighty-nine percent of patients with postoperative aspiration showed recurrent nerve paralysis and 69% of postoperative recurrent nerve paralyses caused varying degrees of aspiration after surgery of the thoracic esophagus. The postoperative deviation or traction of the cervical esophagus may be a cause of aspiration.There are many cases of esophagobronchial fistula formation. Esophageal contents are easily aspirated into bronchial trees, and subsequently aspiration pneumonia occurs. Results of 14 esophageal bypass operations for esophageal fistulas were discussed. Aspiration of esophageal contents was completely prevented by this type of operation. However, the prognosis of patients depended on severity of the tumor.