Single-staged laryngotracheal resection and reconstruction for benign strictures in adults.
Laryngotracheal stenosis (LTS) is a challenging problem, and its management is complex. This study evaluated both short- and long-term outcomes following laryngotracheal resection and anastomosis. Between 1994 and 2006, 37 patients underwent surgery for LTS. The cause of stenosis was post-intubation or post-tracheostomy injury in 28 cases and idiopathic in nine. Pearson's technique was used for anterolateral cricotracheal resection (n=23), and Grillo's technique of providing a posterior membranous tracheal flap was used in cases of circumferential stenosis (n=14). Since 1998, we have modified the techniques in 21 cases, using a continuous 4/0 polydioxanone suture for the posterior part of the anastomosis. No peri-operative mortality was recorded. Three (8.1%) patients developed major complications (two fistulae and one early stenosis) that required a second surgical look. We had 16 minor complications in 14 (37.8%) patients. The long-term results were excellent to satisfactory in 36 patients (97.3%) and unsatisfactory in one (2.7%). Single-staged laryngotracheal resection is a demanding operation, but can be performed successfully with acceptable morbidity in specialized centers. The continuous suture in the posterior part of the anastomosis simplifies the procedure without causing technique-related complications. In our experience, this procedure guaranteed excellent to satisfactory results in more than 90% of patients.
Marulli
Giuseppe
G
Department of Cardiologic, Thoracic and Vascular Sciences, Division of Thoracic Surgery, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
Rizzardi
Giovanna
G
Bortolotti
Luigi
L
Loy
Monica
M
Breda
Cristiano
C
Hamad
Abdel-Mohsen
AM
Sartori
Francesco
F
Rea
Federico
F
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects; D007829:Laryngostenosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013536:Suture Techniques; D013997:Time Factors; D014135:Tracheal Stenosis / Q000209:etiology / Q000601:surgery*; D014140:Tracheotomy / Q000009:adverse effects; D016896:Treatment Outcome