PMC7714922_01
(A) Drawing of the patient's native malformation, which is characterized by the common segment involving both the middle esophagus and distal trachea. (B) Drawing after the first surgery. The common segment was kept on tracheal side. The esophagus disconnected right above and below this segment. Left cervical esophagostomy, Stamm gastrostomy, posterior tracheal splinting, and anterior aortopexy were performed (not depicted). (C) Drawing after multistage esophageal and tracheal reconstruction. Native esophageal reconstruction (end-to-end anastomosis) after performing the traction-and-growth strategy, Nissen fundoplication, and; anterior tracheal external splinting using a Gore-tex  stent were performed.
fped-08-605143-g0001.jpg
PMC7714922_05_fped-08-605143-g0001.jpg
F1
Several rows of extra-mucosal 5/0 non-resorbable stitches were applied between the diseased tracheal segment and this external stent (Figures 3, 1C).
PMC7714922_02
Expiratory airway collapse of the neo-tracheal segment, as observed via: (A) Tracheobronchography (Day 40). (B) Tracheoscopy (Day 865). (C) Dynamic computed tomography (CT) scan (Day 870). (D) Tracheoscopy (Day 1,798). Both tracheobronchography and tracheoscopy (images A,B), comparing expiration and inspiration frames, allow to appreciate esophageal-like appearance of the unsupported segment (due to the absence of cartilaginous rings), as also confirmed at CT scan (image C). At tracheobrochography (image A:inspiration frame), it is possible to appreciate a sort of diverticulum, just above the unsupported segment, which represents the site of separation of the proximal esophageal portion from the common segment. Similarly, in tracheoscopy views (images B,D:inspiration frames), a fovea on the posterior neo-tracheal wall, just above the carina, results from the separation of the distal esophageal portion. The most recent tracheoscopy (image D) confirms the absence of tracheal collapse 2 years after external stenting surgery.
fped-08-605143-g0002.jpg
PMC7714922_07_fped-08-605143-g0002.jpg
F2
Endoscopic follow-ups showed no recurrence of tracheomalacia (Figure 2D).
PMC7714922_03
PMC7714922_04
Expiratory airway collapse of the neo-tracheal segment, as observed via: (A) Tracheobronchography (Day 40). (B) Tracheoscopy (Day 865). (C) Dynamic computed tomography (CT) scan (Day 870). (D) Tracheoscopy (Day 1,798). Both tracheobronchography and tracheoscopy (images A,B), comparing expiration and inspiration frames, allow to appreciate esophageal-like appearance of the unsupported segment (due to the absence of cartilaginous rings), as also confirmed at CT scan (image C). At tracheobrochography (image A:inspiration frame), it is possible to appreciate a sort of diverticulum, just above the unsupported segment, which represents the site of separation of the proximal esophageal portion from the common segment. Similarly, in tracheoscopy views (images B,D:inspiration frames), a fovea on the posterior neo-tracheal wall, just above the carina, results from the separation of the distal esophageal portion. The most recent tracheoscopy (image D) confirms the absence of tracheal collapse 2 years after external stenting surgery.
fped-08-605143-g0002.jpg
PMC7714922_07_fped-08-605143-g0002.jpg
F2
Endoscopic follow-ups showed no recurrence of tracheomalacia (Figure 2D).
PMC7714922_05
(A) Drawing of the patient's native malformation, which is characterized by the common segment involving both the middle esophagus and distal trachea. (B) Drawing after the first surgery. The common segment was kept on tracheal side. The esophagus disconnected right above and below this segment. Left cervical esophagostomy, Stamm gastrostomy, posterior tracheal splinting, and anterior aortopexy were performed (not depicted). (C) Drawing after multistage esophageal and tracheal reconstruction. Native esophageal reconstruction (end-to-end anastomosis) after performing the traction-and-growth strategy, Nissen fundoplication, and; anterior tracheal external splinting using a Gore-tex  stent were performed.
fped-08-605143-g0001.jpg
PMC7714922_05_fped-08-605143-g0001.jpg
F1
Several rows of extra-mucosal 5/0 non-resorbable stitches were applied between the diseased tracheal segment and this external stent (Figures 3, 1C).
Intraoperative photos during anterior tracheal stenting/splinting (Day 1,012). (A) The anterior neo-tracheal wall is exposed through median sternotomy. Several rows of extra-mucosal 5/0 non-resorbable stitches were applied. (B) The stitches are anchored to the ringed hemi-circular Gore-tex  stent in order to suspend the anterior neo-tracheal wall and prevent airway collapse.
fped-08-605143-g0003.jpg
PMC7714922_05_fped-08-605143-g0003.jpg
F3
Several rows of extra-mucosal 5/0 non-resorbable stitches were applied between the diseased tracheal segment and this external stent (Figures 3, 1C).
PMC7714922_06
PMC7714922_07
Expiratory airway collapse of the neo-tracheal segment, as observed via: (A) Tracheobronchography (Day 40). (B) Tracheoscopy (Day 865). (C) Dynamic computed tomography (CT) scan (Day 870). (D) Tracheoscopy (Day 1,798). Both tracheobronchography and tracheoscopy (images A,B), comparing expiration and inspiration frames, allow to appreciate esophageal-like appearance of the unsupported segment (due to the absence of cartilaginous rings), as also confirmed at CT scan (image C). At tracheobrochography (image A:inspiration frame), it is possible to appreciate a sort of diverticulum, just above the unsupported segment, which represents the site of separation of the proximal esophageal portion from the common segment. Similarly, in tracheoscopy views (images B,D:inspiration frames), a fovea on the posterior neo-tracheal wall, just above the carina, results from the separation of the distal esophageal portion. The most recent tracheoscopy (image D) confirms the absence of tracheal collapse 2 years after external stenting surgery.
fped-08-605143-g0002.jpg
PMC7714922_07_fped-08-605143-g0002.jpg
F2
Endoscopic follow-ups showed no recurrence of tracheomalacia (Figure 2D).