Urgent segmental resection as the primary strategy in management of benign tracheal stenosis. A single center experience in 164 consecutive cases.
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.
Krajc
Tibor
T
Department of Thoracic Surgery, Faculty Hospital Bratislava, Slovak Republic. tiborkrajc@gmail.com
Janik
Miroslav
M
Benej
Roman
R
Lucenic
Martin
M
Majer
Ivan
I
Demian
Juraj
J
Harustiak
Svetozar
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D015505:Chest Tubes; D002648:Child; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D056346:Sternotomy; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation; D013908:Thoracotomy; D013997:Time Factors; D014135:Tracheal Stenosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D014138:Tracheoesophageal Fistula / Q000150:complications / Q000601:surgery; D014139:Tracheostomy; D016896:Treatment Outcome; D055815:Young Adult