Patient L.V.N suffered from complex injuries, a long and narrow trachea near the larynx, and a perforation and stenosis of the esophagus following a traffic accident.
This is one of the rare cases of tracheal transplantation combined with esophageal reconstruction surgery in the world's medical literature and the first successful case in Vietnam to date.
In July 2022, patient L.V.N was diagnosed with multiple injuries, including a head injury, facial trauma, closed chest trauma, liver trauma, and underwent combined surgery on the facial bones, neck, and conservative treatment for other damaged organs.
After surgery, the patient was monitored and received intensive care. One month after the tracheotomy, the patient was consulted for conservative treatment and stent placement in the trachea, which failed, and then underwent tracheal resection surgery at a hospital in Hanoi, but was unsuccessful due to complex injuries and stenosis on a long segment of the trachea.
During the treatment of tracheal stenosis in the past, when the tracheotomy was not yet permanent, the patient ate normally through the mouth and received injections of anti-fibrotic medication at the site of the stenotic trachea.
In May 2023, after the 6th injection, the patient developed a milky discharge through the tracheotomy site, diagnosed by gastrointestinal specialists as a tracheoesophageal fistula at the site of the anti-fibrotic injection of the trachea and underwent laparotomy for feeding.
In June 2023, the patient visited the Vietnam-German Friendship Hospital, the patient's body was emaciated, 1.65m tall but weighed only 42kg, diagnosed with a 6.5cm long tracheal injury but could not intervene because the old tracheal resection surgery had been performed, and there was no material for intervention. In addition, the patient's esophagus had a fibrotic organization that caused a complete stenosis, to the point that a 4mm endoscope could not pass through, suspected of vocal cord paralysis…
Given the complex injuries of the patient, the doctors of the Vietnam-German Friendship Hospital consulted and agreed to perform two-stage surgery: Stage one, esophageal reconstruction surgery by cutting and reconnecting the stenotic esophagus or creating an esophagus using a segment of the large intestine; Stage two, tracheal reconstruction surgery by combining a segment of the trachea with a segment of the trachea of the donor.
The surgery was successful. After a period of intensive treatment, the patient was discharged and returned home on June 25, 2024. The patient was re-examined one month later with good physical condition (the patient gained 5kg), the surgical scar was good, the patient ate normally through the mouth and breathed through the nose again. The results of the esophageal and tracheal endoscopy: the surgical scar was good, the grafted tracheal segment was pink, not inflamed, not necrotic, and not stenotic.
