Treatment strategies in the management of severe complications following slide tracheoplasty in children.
OBJECTIVE
This study focuses on the different surgical and endoscopical treatment alternatives when dealing with severe complications after slide tracheoplasty (STP).


METHODS
Retrospective study of patients with symptomatic congenital tracheal stenosis (CTS) admitted to a single institution, between January 1997 and January 2013, surgically treated by means of STP. The following variables were evaluated: demographics, preoperative tracheal stenosis characteristics, associated anomalies and outcome measures.


RESULTS
Cohort included 14 patients (8 males and 6 females) with a mean age of 8.7 months when treated (range, 1-43 m). Eleven patients (78%) showed a long segment CTS (>30% of total tracheal length) and 9 (64%) had associated cardiac or great vessel anomalies (left pulmonary artery sling). Three patients (21%) showed severe postoperative complications that required significant airway reintervention: tracheal resection of a restenotic segment, laser division with balloon dilatation of a residual stenosis and placement of a biodegradable endotracheal stent in an extensive tracheal narrowing. All patients are in good clinical condition with a mean follow-up of 6.3 years (range, 2 months to 16 years).


CONCLUSIONS
STP has become the procedure of choice when dealing with CTS. Although it shows clear advantages compared with other surgical techniques, severe and difficult to manage complications may occur. Surgeons involved in their treatment should be familiar with diverse surgical and endoscopical procedures. Biodegradable airway stenting is a new and promising technique when long and severe post-surgical tracheal stenosis is present.
Pediatric Airway Unit and Pediatric Surgery Division, Department of Pediatrics, Hospital U. 12 de Octubre, Universidad Complutense, Madrid, Spain juan.antonpacheco@salud.madrid.org janton.hdoc@salud.madrid.org.
Juan L
JL
Antón-Pacheco
Pediatric Airway Unit and Pediatric Surgery Division, Department of Pediatrics, Hospital U. 12 de Octubre, Universidad Complutense, Madrid, Spain.
Juan V
JV
Comas
Pediatric Airway Unit and Pediatric Surgery Division, Department of Pediatrics, Hospital U. 12 de Octubre, Universidad Complutense, Madrid, Spain.
Carmen
C
Luna
Pediatric Airway Unit and Pediatric Surgery Division, Department of Pediatrics, Hospital U. 12 de Octubre, Universidad Complutense, Madrid, Spain.
María Isabel
MI
Benavent
Pediatric Airway Unit and Pediatric Surgery Division, Department of Pediatrics, Hospital U. 12 de Octubre, Universidad Complutense, Madrid, Spain.
María
M
López
Pediatric Airway Unit and Pediatric Surgery Division, Department of Pediatrics, Hospital U. 12 de Octubre, Universidad Complutense, Madrid, Spain.
Victoria
V
Ramos
Division of Pediatric Anesthesiology, Hospital U. 12 de Octubre, Madrid, Spain.
M Dolores
MD
Méndez
D001999:Bronchoscopy; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods*; D015607:Stents; D014135:Tracheal Stenosis / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome
Biodegradable airway stent; Bronchoscopy; Children; Slide tracheoplasty; Tracheal stenosis