Tracheal resection and reanastomosis in the neonatal period.
OBJECTIVE
Severe congenital tracheal stenosis is rare. Most of these can be managed conservatively before elective repair. Focal tracheal stenosis has been treated with resection of the involved trachea and primary reanastomosis in older infants. The authors found no reports of repair of this lesion in neonates. Two patients are presented with severe respiratory failure on the first day of life that required extracorporeal life support (ECLS) who underwent successful tracheal resection and reanastomosis (TRR) during the first week of life.


METHODS
A retrospective review was conducted.


RESULTS
Both babies had severe pulmonary hypertension and carbon dioxide retention despite maximal therapy and were placed on ECLS shortly after transfer. One had an isolated stenosis of the upper trachea, and the other had agenesis of the right lung, esophageal atresia with tracheoesophageal fistula, and a tracheal stenosis at the end of a short trachea with a long, narrow left bronchus. Both underwent diagnostic studies and had surgical repair while on ECLS at day 3 and 7 of life without bleeding complications. They were weaned off ECLS 1 and 8 days after surgery. One patient was extubated and did well. The other was extubated transiently, but required a tracheostomy because of left mainstem bronchomalacia. Both are alive and well at 18 and 38 months of age, with no narrowing of the repairs.


CONCLUSIONS
In the setting of severe respiratory failure requiring ECLS support, TRR can be performed safely and successfully in the neonate with focal tracheal stenosis.
Islam
S
S
Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114-2696, USA.
Masiakos
P T
PT
Doody
D P
DP
Schnitzer
J J
JJ
Ryan
D P
DP
D000714:Anastomosis, Surgical / Q000379:methods; D000013:Congenital Abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D004933:Esophageal Atresia / Q000000981:diagnostic imaging / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011859:Radiography; D012720:Severity of Illness Index; D014135:Tracheal Stenosis / Q000151:congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome