Urgent segmental resection as the primary strategy in management of benign tracheal stenosis. A single center experience in 164 consecutive cases

Abstract

The report is a retrospective review of 238 benign tracheal stenoses of various etiologies treated between 1995 and 2008. To show that urgent segmental resection has complication rates similar to elective resection and, therefore, preoperative dilation is not necessary, we analysed records of patients who underwent either standard segmental resections with anterolateral mediastinal tracheal mobilization, single-suture anastomosis and neck flexion; or insertion of T-tube with oval-shaped horizontal arm. Primary segmental resection was performed in 164 patients (68.9%), including 14 cases with concomitant tracheo-esophageal fistula (TEF). T-tube as an initial treatment suited 74 (31.1%) patients. We encountered two partial and one complete anastomotic disruptions following subglottic resections treated by T-tube insertion and costal cartilage tracheoplasty or permanent tracheostomy. Restenosis rate in segmental resection was 3.1%. No difference in complication rate between urgent and elective segmental resections was experienced. We treated a small number of patients by endotracheal stent insertion but the results were discouraging. Urgent segmental resection without prior rigid bronchoscopy dilation is our strategy of choice whenever possible. As an alternative to dilation we prefer temporary insertion of modified T-tube. Stand-alone endoluminal dilation and stenting has yet to prove its safety and long-term efficacy.

A tracheal scaffold of gelatin-chondroitin sulfate-hyaluronan-polyvinyl alcohol with orientated porous structure

“…Nevertheless, there are still some challenges to be solved. One of the complications was related to airway stenosis, which may be caused by the degradation byproduct from implanted biodegradable scaffold materials (De Jong, Bergsma, Robinson & Bos, 2005;Krajc, Janik, Lucenic, Benej & Harustiak, 2010). The scaffold materials thus play an important role in tissue engineering.…”

Complications After Tracheal and Cricotracheal Resection and Anastomosis for Inflammatory and Neoplastic Stenoses

“…9,16,17 Moreover, the complication rate remains high, even in the largest series (15%-39%), 18,19 demonstrating that this surgical procedure should always be considered as a major intervention and potentially associated with life-threatening perioperative events.…”

Postintubation Tracheoesophageal Fistula - Diagnosis, Treatment and Prognosis

“…The options in this case are either oesophageal diversion, or emergency surgery with tracheal resection. Emergency resection of the air duct (if stenosis is present) can also be considered when the fistula is diagnosed in the first 24 to 48 hours from extubation, in patients with a satisfactory health status and lung contamination at minimum levels (6,16,17).…”