Does Successful Segmental Tracheal Resection Require Releasing Maneuvers?

Abstract

known medical diagnoses. The most frequent complaint (50%) was shortness of breath, followed by change in voice, throat tightening, or choking sensation, coughing, throat clearing, excess saliva, globus, and swallowing complaints. The most common related medical diagnosis was GERD (42%), followed by asthma and allergies. Several patients had undergone prior surgeries, laryngeal trauma, illness, or severe emotional stress around time of onset. A laryngoscopic examination revealed hyperkinetic laryngeal behaviors in 38% of patients. Although 26% of patients had complained of dysphagia or globus, only 1 patient had documented pharyngeal dysphagia. Similarly, less than half of those patients who complained of globus actually had GERD. Finally, behavorial therapy was recommended for 80% of patients.Conclusions: ILS includes several behaviorally based disorders manifested as hyperfunctional laryngeal dysfunction. It is critical that ILS be recognized so that patients receive appropriate evaluation and treatment.

An experimental model to investigate initial tracheal anastomosis strength

“…Our study used the same suture type for each tracheal anastomosis, but other authors have described alternative approaches. For example, Merati et al6 describes the use of 2‐0 Prolene for the cartilaginous trachea and 3‐0 Vicryl for the membranous trachea. In laryngotracheal resections, several institutions routinely use Vicryl sutures for tracheal anastomosis and 4‐0 PDS for approximation of the laryngeal mucosa with the membranous trachea 4, 7, 10.…”

“…Early tracheal dehiscence is a rare but devastating complication of segmental tracheal resection. Although dehiscence is rarely mentioned in many of the large cohort studies discussing tracheal resection,1–6 most surgeons who do a great number of tracheal resection procedures have experience with this complication. In fact, series that document this complication demonstrate an incidence rate between 4% and 14.2% 7–12.…”

“…Grillo described the use of PDS suture as more cumbersome without any advantage shown. The continued use of monofilament (PDS) suture in a few series is presumably based on the idea that monofilament adds early strength and support to the anastomosis 2, 5, 6, 19. Thus, investigating the initial anastomotic strength using Vicryl suture for repair and comparing it to repair with monofilament suture such as PDS is an important area that has not been investigated in human tracheal anastomoses.…”

Cervical tracheal resection with cricotracheal anastomosis: experience in adults with grade III–IV tracheal stenosis

“…To achieve this last goal, many laryngotracheal releasing manoeuvres have been proposed, such as tracheal dissection, suprahyoid liberation and even dissection from the anterior mediastinum 13 – 15 . However, in Merati and colleagues' series of 17 tracheal segmental resections with primary anastomosis, with a success rate of 94 per cent, adjuvant releasing manoeuvres were not performed in order to avoid the swallowing problems associated with such manoeuvres 23 . In our series, the above-mentioned tenets of surgical success were respected, and the suprahyoid releasing manoeuvre was standardised in all patients.…”

Endoscopic technique to mark the site of tracheal stenosis for resection

“…However, more recent studies suggest that resection of laryngotracheal stenoses together with primary anastomosis 3 , 4 may be a superior approach in many cases, even in the paediatric population 5 . Although not always necessary, appropriate techniques of laryngeal and tracheal release may be performed to allow for reanastomosis after resection of significant tracheal length 6 . No matter what the limits of excision and reconstruction, the driving principle of segmental resection is to preserve as much healthy trachea as possible above and below the stenotic segment.…”