Việt Nam achieves first successful trachea transplant with oesophageal reconstruction

Doctors at Việt Đức Hospital performing the surgery. — Photo courtesy of Việt Đức Friendship Hospital

HÀ NỘI — Doctors at Việt Đức Friendship Hospital have successfully performed a groundbreaking surgery, transplanting a trachea segment from a brain-dead donor and reconstructing an oesophageal stricture for a patient from Thanh Hóa Province. 

Dr. Dương Đức Hùng, Director of Việt Đức Hospital, on Wednesday said this case is among the rare trachea transplants combined with oesophageal reconstruction surgeries globally and represents the first successful implementation of such a procedure in Việt Nam. 

Dr. Hùng said that this success reaffirms the expertise of Việt Đức Hospital’s physicians and positions Việt Nam on the global map of trachea transplantation, thereby enhancing the credibility of the nation’s healthcare sector.

In July 2022, a 25-year-old man, named L.V.N., was diagnosed with multiple injuries, including traumatic brain injury, facial fractures, chest trauma and liver injury, after a traffic accident. 

He underwent surgery to repair facial bones and the neck area and received conservative treatment for other organ injuries. 

Post surgery, he required intensive care, including a tracheostomy to facilitate breathing. 

Once stabilised, he was transferred to a local hospital for further treatment.

One month after the tracheostomy, L.V.N. was considered for conservative treatment but failed the tracheal dilation and stenting procedures. 

Subsequent surgery to reconnect the trachea at a Hà Nội medical facility was unsuccessful due to the complex and extensive tracheal stricture, leading to a permanent tracheostomy. 

Over the two subsequent years, he relied on gastrostomy feeding and could only breathe through the tracheostomy, which often resulted in ulceration, bleeding and infections.

In May 2023, after a series of anti-scar injections at the stricture site, L.V.N. developed a tracheo-oesophageal fistula, necessitating a gastrostomy for feeding. He continued regular check-ups at Việt Đức Hospital.

Given the patient’s complex injuries, Việt Đức Hospital’s multidisciplinary team, composed of specialists in ear, nose and throat, gastroenterology, thoracic surgery, anaesthesia, tissue banking and nutrition, agreed on a two-stage surgical plan. 

The first stage involved resection and reconstruction of the cervical oesophagus stricture, while the second stage focused on reconstructing the larynx and transplanting a tracheal segment from a brain-dead donor.

The first stage of the surgery was performed in April, followed by the second stage in May, which included trachea transplantation and stent placement. After intensive post-operative care, L.V.N. was discharged on June 25.

One month after discharge, L.V.N. showed significant improvement, gaining 5kg, with well-healed surgical scars, normal oral intake and nasal breathing. Three months post-operation, he gained 10 kg, maintained good health and continued to breathe and eat normally. He is scheduled to have the tracheal stent removed between the fifth and sixth months.

Dr. Hùng said that this success offers hope for patients with long tracheal segment injuries over 6cm, marking a significant advancement in medical science and surgery in Việt Nam. 

He emphasised that trachea transplant surgery remains a challenge globally, with few short-term success reports.

This groundbreaking procedure at Việt Đức Hospital represents a promising development for future complex surgeries and the advancement of the country’s healthcare capabilities. — VNS