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Hyperbaric Oxygen Therapy in the Treatment of Anastomotic Complications Arising from Tracheal and Esophageal Surgeries

Various anastomotic complications could crop up once individuals go through either tracheal or oesophageal surgeries. Most of the organs on which anastomotic surgeries are performed are those that have been affected by cancerous and malignant growths. The resectioning and reconstruction processes that address the medical defects around the trachea and esophagus sometimes fall short, especially during postoperative care. Even though the complications are quite rare, they have a huge impact on the patient’s quality of life once they occur. The complications which mostly involve leakage of blood and other body fluids are associated with high rates of morbidity and mortality. Anastomotic dehiscence which involves the separation of sutures a short while after the operations are completed forms part of the complications as well. Some of the treatment options that have been explored to take care of the complications include reoperation, tracheostomy, bronchoscopy, and T-tube placement.

Mechanism of Action for Hyperbaric Oxygen Therapy (HBOT)

HBOT has been used widely in the management of the different complications that crop up after anastomotic procedures on the trachea and esophagus. Tissue oxygenation addresses the regional ischemia which is highly associated with anastomotic complications. The increased supply of oxygenated blood aids in the rapid healing of the affected tissues. Prolonged hypoxia and perfusion are addressed as well.

The mucosa layer is also restored by increasing oxygen concentration in the affected tissues. Once the partial pressure of oxygen is increased, the compromised tissues on which resection and reconstruction have been performed can receive ample oxygen and nutrients. This had the effect of increasing cellular metabolism which also includes cell repair and subsequently wound healing. Also, with angiogenesis and increased blood supply, tissue hypoxia is eliminated thus stopping the tissue damage that comes with that. 

HBOT also intervenes in instances of excessive inflammation which is mostly linked to surgical trauma. The anti-inflammatory properties of the high-pressure oxygen are key to a smooth healing process of the re-sectioned and reconstructed body parts. In getting rid of inflammation, granulation tissue formation associated with anastomotic complications is addressed as well. The oxygen provided aids in tissue repair therefore the parts that have been operated on can rejoin with ease. The immunity of the tracheal and esophageal parts being reconstructed is boosted as well. HBOT also eliminates the chances of the formation of fistulas as a result of the anastomotic complications; the fistulas are quite fatal. With the introduction of HBOT, the patients who are recovering from the surgeries can enjoy improved quality of life. They can leave hospitals sooner, incur lesser hospitalization and treatment costs, and suffer less from affected functionality of the organs. Once the patients are fully recovered, they can get back to swallowing and speaking normally as the two are greatly affected by the anastomotic complications. 

References

Stock, C. T., Gukasyan, N., Muniappan, A., Wright, C. D., & Mathisen, D. J. (2014). Hyperbaric oxygen therapy for the treatment of anastomotic complications after tracheal resection and reconstruction. The Journal of Thoracic and Cardiovascular Surgery, 147(3), 1030–1035. https://doi.org/10.1016/j.jtcvs.2013.11.014

Tapias, L. F., Wright, C. D., Lanuti, M., Muniappan, A., Deschler, D. G., & Mathisen, D. J. (2020). Hyperbaric oxygen therapy in the prevention and management of tracheal and oesophageal anastomotic complications. European Journal of Cardio-Thoracic Surgery, 57(6), 1203–1209. https://doi.org/10.1093/ejcts/ezz364

 

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