title: First-line tracheal resection and primary anastomosis for postintubation tracheal stenosis.
abstract: Introduction Tracheal stenosis following intubation is the most common indication for tracheal resection and reconstruction. Endoscopic dilation is almost always associated with recurrence. This study investigated first-line surgical resection and anastomosis performed in fit patients presenting with postintubation tracheal stenosis. Methods Between February 2011 and November 2014, a prospective study was performed involving patients who underwent first-line tracheal resection and primary anastomosis after presenting with postintubation tracheal stenosis. Results A total of 30 patients (20 male) were operated on. The median age was 23.5 years (range: 13-77 years). Seventeen patients (56.7%) had had previous endoscopic tracheal dilation, four (13.3%) had had tracheal stents inserted prior to surgery and one (3.3%) had undergone previous tracheal resection. Nineteen patients (63.3%) had had a tracheostomy. Eight patients (26.7%) had had no previous tracheal interventions. The median time of intubation in those developing tracheal stenosis was 20.5 days (range: 0-45 days). The median length of hospital stay was 10.5 days (range: 7-21 days). The success rate for anastomoses was 96.7% (29/30). One patient needed a permanent tracheostomy. The in-hospital mortality rate was 3.3%: 1 patient died from a chest infection 21 days after surgery. There was no mortality or morbidity in the group undergoing first-line surgery for de novo tracheal lesions. Conclusions First-line tracheal resection with primary anastomosis is a safe option for the treatment of tracheal stenosis following intubation and obviates the need for repeated dilations. Endoscopic dilation should be reserved for those patients with significant co-morbidities or as a temporary measure in non-equipped centres.
authors.affiliation: Ain Shams University Hospital , Cairo , Egypt.
authors.forename: H
authors.initials: H
authors.lastname: Elsayed
authors.affiliation: Ain Shams University Hospital , Cairo , Egypt.
authors.forename: A M
authors.initials: AM
authors.lastname: Mostafa
authors.affiliation: Ain Shams University Hospital , Cairo , Egypt.
authors.forename: S
authors.initials: S
authors.lastname: Soliman
authors.affiliation: Ain Shams University Hospital , Cairo , Egypt.
authors.forename: T
authors.initials: T
authors.lastname: Shoukry
authors.affiliation: Ain Shams University Hospital , Cairo , Egypt.
authors.forename: A A
authors.initials: AA
authors.lastname: El-Nori
authors.affiliation: Ain Shams University Hospital , Cairo , Egypt.
authors.forename: H Y
authors.initials: HY
authors.lastname: El-Bawab
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D014132:Trachea / Q000601:surgery*; D014135:Tracheal Stenosis / Q000601:surgery*; D055815:Young Adult
keywords: Postintubation injury; Stenosis; Tracheal resection