Aortopexy with tracheal reconstruction for postoperative tracheomalacia in congenital tracheal stenosis.
OBJECTIVE
Congenital tracheal stenosis is a rare condition and can be difficult to manage. One source of difficulty is postoperative tracheomalacia requiring long-term tracheal stenting. To prevent symptomatic postoperative tracheomalacia, we have been adding aortopexy to tracheal reconstruction since 2008. The aim of this study was to evaluate efficacy of aortopexy for preventing postoperative tracheomalacia after reconstruction of congenital tracheal stenosis.


METHODS
Retrospective chart review was conducted. From October 2003 to March 2011, 24 had tracheal reconstruction without aortopexy (group A) and 8 with aortopexy (group B). Statistical analysis was performed using Fisher's Exact test.


RESULTS
One had anastomotic leakage in group A, and 1, in group B (P = .44). Eleven patients required tracheostomy because of postoperative tracheomalacia confirmed by postoperative bronchoscopy in group A vs none in group B (P = .029).


CONCLUSIONS
We found that aortopexy with tracheal reconstruction reduced the need for postoperative tracheostomy in this patient group. Although there is a potential risk of anastomotic leakage because of the suspension suture on the anterior tracheal wall to aorta, we did not detect an increased incidence after aortopexy. Thus, aortic suspension may be a useful adjunct to prevent symptoms of tracheomalacia in these patients.
Department of Pediatric Surgery, Kobe Children's Hospital, Kobe 654-0081, Japan. yokoi_kch@hp.pref.hyogo.jp
Akiko
A
Yokoi
Hiroshi
H
Arai
Yuko
Y
Bitoh
Makoto
M
Nakao
Yoshihiro
Y
Oshima
Eiji
E
Nishijima
D057868:Anastomotic Leak; D001011:Aorta / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery; D013536:Suture Techniques; D014132:Trachea / Q000473:pathology / Q000601:surgery*; D014135:Tracheal Stenosis / Q000151:congenital* / Q000601:surgery*; D055090:Tracheomalacia / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery