Tracheal resection and anastomosis (original) (raw)
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Laryngotracheal resection: perioperative management and surgical technique
Journal of Visualized Surgery, 2018
In the landscape of tracheal surgery, subglottic stenosis still represents a demanding condition because of the technical and functional implications surrounding the peculiar anatomy of the lower larynx. Since the basis for a safe and complete surgical excision of subglottic stenosis with primary laryngotracheal anastomosis have been described, results from large published series have reported excellent and durable success in this setting in view of low morbidity and mortality rates, thus affirming the role of surgery as the definitive treatment of choice for benign stenosis. In recent years, novel techniques are been developed that pertain in particular the treatment of idiopathic stenosis. This article focuses on tricks and tips about the main technical aspects and perioperative management in the field of laryngotracheal resection.
Surgical management of laryngotracheal stenosis in adults
European Archives of Oto-Rhino-Laryngology, 2005
The purpose was to evaluate the outcome following the surgical management of a consecutive series of 26 adult patients with laryngotracheal stenosis of varied etiologies in a tertiary care center. Of the 83 patients who underwent surgery for laryngotracheal stenosis in the Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Lausanne, Switzerland, between 1995 and 2003, 26 patients were adults ( ‡16 years) and formed the group that was the focus of this study. The stenosis involved the trachea (20), subglottis (1), subglottis and trachea (2), glottis and subglottis (1) and glottis, subglottis and trachea (2). The etiology of the stenosis was post-intubation injury (n =20), infiltration of the trachea by thyroid tumor (n =3), seeding from a laryngeal tumor at the site of the tracheostoma (n =1), idiopathic progressive subglottic stenosis (n =1) and external laryngeal trauma (n =1). Of the patients, 20 underwent tracheal resection and end-to-end anastomosis, and 5 patients had partial cricotracheal resection and thyrotracheal anastomosis. The length of resection varied from 1.5 to 6 cm, with a median length of 3.4 cm. Eighteen patients were extubated in the operating room, and six patients were extubated during a period of 12 to 72 h after surgery. Two patients were decannulated at 12 and 18 months, respectively. One patient, who developed anastomotic dehiscence 10 days after surgery, underwent revision surgery with a good outcome. On long-term outcome assessment, 15 patients achieved excellent results, 7 patients had a good result and 4 patients died of causes unrelated to surgery (mean follow-up period of 3.6 years). No patient showed evidence of restenosis. The excellent functional results of cricotracheal/tracheal resection and primary anastomosis in this series confirm the efficacy and reliability of this approach towards the management of laryngotracheal stenosis of varied etiologies. Similar to data in the literature, post-intubation injury was the leading cause of stenosis in our series. A resection length of up to 6 cm with laryngeal release procedures (when necessary) was found to be technically feasible.
A Multi-Modality Surgical Management in Laryngeal Stenosis
Bengal Journal of Otolaryngology and Head Neck Surgery, 2018
Introduction Postintubation laryngo-tracheal stenosis requires a precise diagnosis and an experienced operator in both endoscopic and surgical treatment. This report presents surgically treated cases of laryngo-tracheal stenosis secondary to long-term intubation/ tracheostomy with review of the literature. Case Reports In this retrospective study, we present 5 cases (23-year-old male, 13 year old male, 22 year old male, 19 year old male and 33 year old female) of post-intubation/tracheostomy laryngo-tracheal stenosis (glottic/subglottic) stenosis in the year 2016 to 2017. Each patient was managed differently. A patient with history of multiple subglottic stenosis dilations and stenting underwent open surgical subglottic stenosis resection and anastomosis, LASER assisted resection of stenosis with stenting was done in a patient with history of dilation, LASER assisted resection and dilation followed by Mitomycin C application was done in another patient with history of poisoning, pla...
Laryngotracheal resection for benign stenosis
Shanghai Chest, 2018
Surgical treatment of benign subglottic stenosis encases a current therapeutic trouble. The need to achieve a complete resection with respect to recurrent nerves and proximity of the anastomosis to the vocal cords are the main technical issues. Interventional endoscopic treatments play a limited role in this setting due to the high rate of recurrences requiring repeated procedures. Surgical resection and reconstruction with primary anastomosis represent the curative treatment of choice for most subglottic strictures, allowing definitive and stable high success rate on long-term. Technical aspects and surgical results are discussed in the present review.
European Journal of Cardio-thoracic Surgery, 2006
Objective: Partial tracheal resection (Küster operation (KO)) and cricotracheal resection (Pearson operation (PO)) are currently the standard operative techniques in the curative treatment of tracheal and cricotracheal stenosis, respectively. This study aims to analyze the outcomes of tracheal and cricotracheal resection when a specific protocol is applied. Methods: Between 1990 and 2004 we treated 54 patients with laryngotracheal stenosis. The mean age was 44.9 years with a sex ratio of 1:1. All patients were treated according to the random protocol ''Lesions of the main airway (MA) protocol,'' which considers the following stenosis variables: stage of development (S), caliber (C), and length (L). We performed 38 Küster operations, 14 Pearson operations, and 2 combined Pearson-Küster-Rethi operations (ROs). Results: Overall mortality of the series was 1.85%, with a specific morbidity of 27.7%. A total of 96.2% of patients were cured (85.6% of Pearson operation and 100% of Küster operation). We performed 3.7% re-interventions (14.2% of Pearson operation and 0% of Küster operation), and the failure rate was 3.7% (14.4% of Pearson operation and 0% of Küster operation). We had 27.5% who had postoperative complications (28.5% of Pearson operation and 26.3% of Küster operation). The most frequent complications were restenosis (14.2%), granulation tissue (13.1%), edema (10.5%), anastomotic dehiscence (7.1%), and tracheoesophageal fistula (7.1%). In terms of the SCL variables, significant differences were only observed with respect to morbidity between the S4 group and the other cases without tracheoesophageal fistula in the Küster operation group; we found no differences in Pearson operation. Conclusions: Application of the Main Airway protocol allowed development of a strategy for the surgical treatment of main airway stenosis. This, in turn, enabled a strict selection of cases and meticulous preoperative preparation that, coupled with a highly effective surgical technique, led to excellent outcomes with minimal sequel. The presence of tracheoesophageal fistula could increase the complications. # 2005 Published by Elsevier B.V.
International Journal of Head and Neck Surgery
Aim and objective: The study aimed to review the clinical and surgical outcomes of partial cricotracheal resection (PCTR) and anastomosis in the management of laryngotracheal stenosis (LTS). Materials and methods: The study used a retrospective analysis of adult patients managed in a University Hospital who underwent PCTR and anastomosis from 2007 to 2017. Results: During the 10 years, 53 patients were diagnosed with cricotracheal or tracheal stenosis. Prolonged orotracheal intubation and blunt trauma were the leading causes of upper LTS. The stenosis were classified as per Myer-Cotton classification. Thirty-seven were chosen for surgical intervention. Of the patients who underwent surgical intervention, PCTR was done in 33, resection and anastomosis in 3 and 1 underwent balloon dilatation. Tube displacement and surgical emphysema were the most common complication seen postoperatively. Ninety-seven percent of the patients who underwent surgery were successfully decannulated. Conclusion: Partial cricotracheal resection is an established surgical procedure with low morbidity and mortality. Risk factors for increased morbidity include diabetes mellitus (DM), lengthy resection, and children. Rib autograft was found to be ideal for reconstruction. Prompt observation and intervention of morbidity is the key to good clinical outcomes.
Laryngotracheoplasty in the management of subglottic stenosis
International Journal of Pediatric Otorhinolaryngology, 1989
(LTP) has revolutionized the surgical management of subglottic stenosis in children. A lo-year review of patients at the Children's Hospital of Philadelphia yielded 27 patients who had undergone a LTP. LTP with an anterior cartilage graft was utilized in over 80% of procedures. Morbidity was minimal, and there were no deaths. In this series, 78% of patients have been successfully decannulated. LTP has reduced the time necessary for decannulation in children with chronic tracheostomies as a result of subglottic stenosis.
Laryngotracheal Anastomosis: Primary and Revised Procedures
Laryngoscope, 2001
Objectives Acquired upper airway stenosis is usually associated with a complex of pathological conditions at the high tracheal and the subglottic levels. Reported reconstructive techniques include widening by incorporation of grafts, segmental resection, and anastomosis or combined procedures. The management of recurrent stenosis after reconstructive surgery is a major challenge and has rarely been discussed in the literature. The purposes of the present study are to compare the clinical course of primary versus revised reconstructive procedures and to analyze the effect of age, diabetes, chronic lung disease, grading of stenosis, extent of resection, and revised procedures on the operative rate of success.Study Design A cohort study in a tertiary referral medical center.Methods The clinical course of 23 consecutive patients undergoing laryngotracheal anastomosis was studied comparing a group of 13 primary with 10 revision procedures. Seventeen patients underwent cricotracheal and six patients thyrotracheal anastomoses. All patients but one were tracheotomized before the definitive reconstructive procedure. Suprahyoid release was routinely performed except for two cases, and only one patient required sternotomy. The Wilcoxon test was used to examine the relationship between preoperative clinical parameters and the postoperative success (i.e., airway patency).Results Twenty-two of 23 patients (95.6%) had successful decannulation. Four patients required a revision procedure because of repeat stenosis at the site of the anastomosis (2) or distal tracheal malacia (2). Residual airway stenosis of less than 50% was noted in six patients, although only three complained of dyspnea during daily-activity exertion. There was no associated mortality. Complications included subcutaneous emphysema (4), granulation tissue formation (3), pneumonia (2), cardiac arrhythmia (2), and one each of pneumomediastinum, neck hematoma, and urosepsis. Protracted aspirations were noted in one patient who had revision surgery. Age was the only parameter that correlated with postoperative airway patency (P <.07), whereas the presence of chronic obstructive lung disease and diabetes, grade of stenosis, type of surgery, and revision surgery were found to be insignificant.Conclusions The clinical course of laryngotracheal anastomosis in primary and revised procedures was similar in our group of patients. The operation can be performed safely, with an expected high rate of success and acceptable morbidity.
Complete subglottic tracheal stenosis managed with rigid bronchoscopy and T-tube placement
Lung India, 2016
A 24-year-old man was referred to our facility for the management of subglottic stenosis. Three years ago, the patient had required endotracheal intubation followed by tracheostomy after sustaining head injury in a road traffic accident. Attempts at decannulation were unsuccessful as there was significant respiratory distress on removing the tracheostomy tube. Subsequent evaluation revealed the presence of subglottic stenosis located 0.5-1 cm from the vocal cords. Over the next 3 years, the patient underwent several procedures for the management of tracheal stenosis that included bougie dilatation, laser excision of the stenosis, cricoid split with cartilage graft placement, and surgical excision and repair of the stenosis. Unfortunately, all the attempts failed, and the patient continued to require a tracheostomy. The patient was then referred to our center for further management.
Long-term results of laryngotracheal resection for benign stenosis
Objective: We report the long-term results of our 16-year experience with laryngotracheal resection for benign stenosis. Methods: Between 1991 and 2006, 35 consecutive patients (19 males, 16 females) underwent laryngotracheal resection for subglottic postintubation (32) or idiopathic (3) stenosis. Mean age was 43 years (range 14-71). At the time of surgery 13 patients presented with tracheostomy and 7 with a Dumon stent. The upper limit of the stenosis was from 0.6 to 1.5 cm below the vocal cords. The length of airway resection ranged between 1.5 and 6 cm. Suprahyoid release was performed in two patients and pericardial release in one. Nine patients had psychiatric and/or neurological post-coma disorders. Mean follow-up is over 5 years (61 months; range 3-194). Results: There was no perioperative mortality. Thirty patients (85.7%) had excellent or good anatomic and functional results. Four patients (11.4%) presented restenosis at a distance of 25-110 days from the operation. Restenosis was successfully treated by endoscopic procedures in all four patients. One patient (2.9%) presented anastomotic dehiscence that required temporary tracheostomy closed after 1 year with no sequelae. Three patients (8.4%) had wound infection. Long-term follow-up was uneventful also in patients who had early complications. Conclusions: Long-term follow-up confirms that laryngotracheal resection is the definitive curative treatment for benign subglottic stenosis. Surgical complications can be successfully managed by non-operative procedures. Despite the occurrence of early complications, excellent and stable results can still be obtained at long term. #