Tracheal resection with end-to-end anastomosis for post-intubation cervical tracheal stenosis: study of 14 cases

Abstract

Background and objectives: The incidence of acquired laryngeal stenosis is increasing. This retrospective study aimed to assess the long term results of circumferential resection with end-to-end tracheal anastomosis for isolated post-intubation stenosis of the cervical trachea, and to review the relevant literature.Methods: Twelve male and two female patients (aged 16-30 years, mean age 24 years) treated between February 2003 and December 2008 were included. Hospital and office records were reviewed and relevant surgical details recorded.Results: Indications for tracheal resection anastomosis were post-intubation stenosis (78.57 per cent) and trauma (21.42 per cent). One to five tracheal rings were resected (i.e. 1-2.5 cm of cervical trachea). Tracheal anastomosis was considered successful if the patient remained asymptomatic for 24 months of close follow up (involving regular flexible bronchoscopy and neck X-ray). The anastomotic success rate was 92.85 per cent.Conclusion: Tracheal resection and end-to-end anastomosis is relatively safe and reliable for definitive treatment of benign tracheal stenosis in appropriate patients. Local application of mitomycin C prevents granulation and aids long term airway patency.

Laryngotracheal resection and reconstruction for subglottic tracheal stenosis – our experience of 32 cases

“…Cricotracheal resection and thyrotracheal anastomosis along with laryngotracheal reconstruction are now assuming the standard of care for symptomatic subglottic stenosis. This treatment option has been shown to achieve up to 90% decannulation rate in paediatric patients with subglottic stenosis, and 92% in adult patients with severe cervical tracheal stenosis.…”

Tracheal reconstruction using chondrocytes seeded on a poly(l-lactic-co-glycolic acid)-fibrin/hyaluronan

“…Replacement or reconstruction of the trachea is one of the most difficult procedures in head and neck surgery . An optimal treatment has not yet been found, but current treatments for tracheal disease mainly involve surgical repair . Total resection of pathologic trachea followed by end‐to‐end anastomosis is the favored treatment; however, the total resectable length cannot exceed 30% of the trachea in children or 6 cm in adults .…”

“…3 An optimal treatment has not yet been found, but current treatments for tracheal disease mainly involve surgical repair. 4,5 Total resection of pathologic trachea followed by end-to-end anastomosis is the favored treatment; however, the total resectable length cannot exceed 30% of the trachea in children or 6 cm in adults. 6 In addition, if indicated, reconstruction with various cartilage substitutions, such as costal cartilage, buccal mucosa, or artificial materials, has been performed after partial tracheal resection with limited success.…”

Flow volume loop as a diagnostic marker

“…Complete resection of the stenosed airway and anastomosis of the normal airway are the most appropriate methods of treatment. [11] In a minority of patients, who have short-segment stenosis and intact cartilage rings, non-surgical procedures such as dilatation, laser therapy, or granulation tissue extraction via bronchoscopy, and local and systemic steroids can be effective. Topical application of Mitomycin-C, an anti-proliferative agent, can be used to treat tracheal stenosis as it can inhibit cell division, as has been described in some studies.…”