title: The "Hitch Stitch": An Effective Method of Preventing Migration in High Tracheal Stenosis.
abstract: BACKGROUND
  The incidence of caudal stent migration in high tracheal stenting is 13-21% and is common with silicone stents. This can lead to major problems, including emergency repeat procedures. Several antimigration methods are described, but have limitations in terms of their success rate, availability, cost or ease of the procedure.
  
  
  OBJECTIVE
  We describe an innovative method of stent migration prevention using a simple percutaneous anchoring "hitch stitch", validated in a large series.
  
  
  METHODS
  After tracheal stent placement, an Ethilon suture was passed into the stent lumen through an 18-G needle. To take this suture back to the exterior to complete the stitch, a retrieval loop was passed through another 14-G percutaneous cannula inserted into the stent lumen. Bronchoscopically, using a forceps the first suture was pulled inside the loop, the loop was retracted, the suture was exteriorized, and the knot was completed and embedded subcutaneously. While removing the stent, an endoscopic scissor was used to cut the stitch to free the stent.
  
  
  RESULTS
  A total of 42 "hitch stitches" were done in 29 patients over 5 years, predominantly for silicone stents. Indications for stenting included postintubation tracheal stenosis (83.3%), malignancy (11.9%) and tracheoesophageal fistula (4.8%, metal stents). The procedure was successful in 41/42 (97.6%) patients. Stitch removal was uncomplicated.
  
  
  CONCLUSIONS
  This is the largest series of an external stent anchoring procedure as a migration prevention strategy in high tracheal stenting, applicable to both silicone and metal stents. Stent migration prevention using this "hitch stitch" is simple, safe and successful, without any complications during stent removal.
authors.affiliation: Department of Pulmonary, Critical Care and Sleep Medicine, Apollo Hospitals, Bangalore, India.
authors.forename: Ravindra M
authors.initials: RM
authors.lastname: Mehta
authors.forename: Abhinav
authors.initials: A
authors.lastname: Singla
authors.forename: Aashish
authors.initials: A
authors.lastname: Shah
authors.forename: Chakravarthi
authors.initials: C
authors.lastname: Loknath
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001999:Bronchoscopy; D002648:Child; D005260:Female; D005548:Foreign-Body Migration / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012828:Silicones; D015607:Stents; D013536:Suture Techniques; D014135:Tracheal Stenosis / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D012828:Silicones