Postoperative problems of tracheal resection.

Abstract

AbstractWith the advent of the intermittent positive pressure breathing apparatus and cuffed endotracheal tubes, the problem of tracheal stenosis has increased in both incidence and severity. The lesion may be at the tracheotomy stoma or at the site of the tracheal tube cuff, or both. Treatment of severe cases revolves around primary tracheal resection and anastomosis, often with laryngeal release procedures. This report reviews all cases of tracheal stenosis and resection at the Upstate Medical Center, and presents postoperative problems of significance.Twenty‐three consecutive cases of tracheal stenosis were found, 20 of which followed tracheotomy. These were equally prevalent at both stomal and cuff sites, contributing factors being infection and mechanical ventilators, respectively, Eighteen patients were operated upon, all but two undergoing direct resection with end‐to‐end anastomosis. Laryngeal release was performed simultaneously in seven patients.Despite particular postoperative care, 50 percent (9/18) developed significant complications after surgery, including re‐stenosis and/or granulation tissue formation, aspiration, innominate artery hemorrhage, and vocal cord paralysis. These problems ensued despite neck bracing, antibiotics and steroids, and meticulous surgical technique. Two of the patients with re‐stenosis could be controlled only by another tracheal resection.The control of superimposed infection, painstaking surgical manipulation, and relaxation of all tension on the anastomosis line by extensive tracheal mobilization are all methods used to circumvent these problems. Although laryngeal release will allow increased tracheal mobility in and of itself, it also may cause deglutitive dysfunction, as seen in several of our patients and should be used with discretion.