External Fixation of Proximal Tracheal Airway Stents: A Modified Technique

Majid, Adnan; Fernández-Bussy, Sebastián; Kent, Michael; Folch, Erik; Fernández, Liliana; Cheng, George Z.; Gangadharan, Sidhu P.

doi:10.1016/j.athoracsur.2012.01.094

Cited by 31 publications

(29 citation statements)

References 7 publications

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“…In patients who are unfit for surgery (high-risk patients, patients refusing surgical options), tracheal stents are a good option [16, 17]. Recently, studies have been initiated to investigate treatment options (a tissue-engineered airway, revascularized allografts in the heterotopic position, and cryopreserved aortic allografts) for extensive lesions in postintubation tracheal stenosis [18–20].…”

Section: Discussionmentioning

confidence: 99%

Metallic Stents for Proximal Tracheal Stenosis: Is It Worth the Risk?

Bansal

Dhingra

Ghai

et al. 2012

Case Reports in Otolaryngology

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Objective. To demonstrate the risk associated with blocked proximal tracheal stents when a patient presents with acute respiratory distress, with blockage of stent and what is the best management we can offer without damage to the stent and its associated complications.Case Report. A 22-yr-old, male patient, presented in severe respiratory distress. He had history of corrosive poisoning for which he was tracheotomised. A stainless steel wire mesh stent was placed in the trachea, from the subglottis, to just above the carina. One month later, he presented with a critically compromised airway with severe respiratory distress. Emergency tracheostomy was done and the metallic stent had to be cut open, in order to provide an airway.Conclusion. Management of blocked proximal stents with patient in respiratory distress remains a challenge. Formation of granulation tissue is common and fibreoptic bronchoscopic assisted intubation may not always be possible. A regular follow up of all patients with stents is essential. Placement of stents within a few centimetres of cricotracheal junction should not be encouraged for long term indications.

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Section: Discussionmentioning

confidence: 99%

Metallic Stents for Proximal Tracheal Stenosis: Is It Worth the Risk?

Bansal

Dhingra

Ghai

et al. 2012

Case Reports in Otolaryngology

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“…This aspect made this antimigration strategy very important, to maintain the stent position covering the fistula. Apart from 1 patient in the series by Majid et al [10] , our series is the only one to describe external fixation of the metal stents as an effective strategy in such a situation.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the fixation device is not commonly available. Majid et al [10] also described an external fixation procedure in 9 patients, creating a similar loop, using a special endo-close suturing device with a notched stylet as a suture recovery device to complete the loop. In addition, a silicone button was incorporated on the skin surface as a base to complete the knot.…”

Section: Discussionmentioning

confidence: 99%

The “Hitch Stitch”: An Effective Method of Preventing Migration in High Tracheal Stenosis

et al. 2016

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Background: The incidence of caudal stent migration in high tracheal stenting is 13-21% and is common with silicone stents. This can lead to major problems, including emergency repeat procedures. Several antimigration methods are described, but have limitations in terms of their success rate, availability, cost or ease of the procedure. Objectives: We describe an innovative method of stent migration prevention using a simple percutaneous anchoring “hitch stitch”, validated in a large series. Methods: After tracheal stent placement, an Ethilon suture was passed into the stent lumen through an 18-G needle. To take this suture back to the exterior to complete the stitch, a retrieval loop was passed through another 14-G percutaneous cannula inserted into the stent lumen. Bronchoscopically, using a forceps the first suture was pulled inside the loop, the loop was retracted, the suture was exteriorized, and the knot was completed and embedded subcutaneously. While removing the stent, an endoscopic scissor was used to cut the stitch to free the stent. Results: A total of 42 “hitch stitches” were done in 29 patients over 5 years, predominantly for silicone stents. Indications for stenting included postintubation tracheal stenosis (83.3%), malignancy (11.9%) and tracheoesophageal fistula (4.8%, metal stents). The procedure was successful in 41/42 (97.6%) patients. Stitch removal was uncomplicated. Conclusion: This is the largest series of an external stent anchoring procedure as a migration prevention strategy in high tracheal stenting, applicable to both silicone and metal stents. Stent migration prevention using this “hitch stitch” is simple, safe and successful, without any complications during stent removal.

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“…Complications of airway stents include: granulation formation, partial/complete airway occlusion, infection, biofilm formation, and stent migration. In particular, stent migration has been commonly reported in the literature, ranging from 16–34% . Techniques to prevent migration include appropriate stent size, design of stents, or methods to secure the stent in place .…”

Section: Introductionmentioning

confidence: 99%

“…In particular, stent migration has been commonly reported in the literature, ranging from 16–34% . Techniques to prevent migration include appropriate stent size, design of stents, or methods to secure the stent in place . Multiple techniques to endoscopically secure stents or keels exist, but these are oftentimes tedious and cumbersome, and can even require devoted surgical instruments (ie, Lichtenberger needle) .…”

Section: Introductionmentioning

confidence: 99%

The suction‐assisted endoscopic suture technique: A simple method for endotracheal suturing

Charous

Westfall

2019

The Laryngoscope

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Background: Silicone stents are commonly employed to treat subglottic stenosis. A frequent complication is the tendency of stents to migrate. As such, various techniques to secure stents have been developed over the years, none of which have gained large popularity. We present a novel, low-cost, and easy-to-perform technique herein.Objectives: To describe a novel surgical technique to secure silicone stents and prevent migration for management of subglottic stenosis.Materials and Methods: After standard excision and dilation of stenotic portions in the subglottic or trachea. A silicone stent is introduced in a standard fashion. To secure the stent, an 18-G needle loaded with braided suture is inserted through skin, trachea, and stent. Endoscopic visualization then permits the surgeon to grasp the suture with forceps. A separate transcutaneous puncture site is performed with an 18-G needle attached to a 10-cc syringe (plunger removed) and blue tip suction within the empty syringe, creating an airtight suctioning tool. The grasped suture is gently introduced into the eye of the needle and quickly travels into the 10-cc syringe with suction assist, leaving both extracorporeal ends of the suture to tie.Results: This stitch has been employed on seven occasions on four patients. There have been no episodes of stent migration. A laboratory model found the 18-G needle and braided 3-0 suture performed optimally.Conclusions: We present a novel surgical technique to secure silicone stents in management subglottic or tracheal stenosis.

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External Fixation of Proximal Tracheal Airway Stents: A Modified Technique

Cited by 31 publications

References 7 publications

Metallic Stents for Proximal Tracheal Stenosis: Is It Worth the Risk?

Metallic Stents for Proximal Tracheal Stenosis: Is It Worth the Risk?

The “Hitch Stitch”: An Effective Method of Preventing Migration in High Tracheal Stenosis

The suction‐assisted endoscopic suture technique: A simple method for endotracheal suturing

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