Resection of the trachea for cicatrical stenosis

Abstract

Tracheal stenosis represents a serious complication of tracheostomy or of endotracheal intubation. The objective of this article was to evaluate the results of resective therapy of patients with tracheal stenosis. In 41 patients treated by tracheal resection for tracheal stenosis the diagnosis was established by bronchoscopy, tracheal tomography or CT. The following parameters were evaluated: the reasons for artificial pulmonary ventilation, basic parameters of stenosis (site of stenosis, length, diameter), the relationship between the duration of cannulation and asymptomatic interval, and postoperative complications. The most frequent reason for cannulation was trauma (n = 23), most patients were cannulated for 4-5 weeks (n = 16), the symptoms of stenosis appeared mostly within 4-5 weeks (n = 11) after decannulation. The asymptomatic interval was longer in patients with longer periods of cannulation (p < 0.01) than in patients with a shorter cannulation period. The most frequent site of stenoses was the medium third of the trachea (n = 22). The longest resected section measured 60 mm. In 3 patients (7.3 %) a tracheoesophageal fistula was found together with the stenosis. In 3 patients (7.3 %) restenosis appeared. Tracheocutaneous fistula with osteomyelitis of the sternum developed in one patient. Granulation tissue on the anastomosis site (n = 4, 9.7 %) was treated by laser or disappeared spontaneously. None of the patients died within 30 days after operation. Resection is the optimum therapeutic method for tracheal stenosis with low postoperative mortality and a small number of postoperative complications. Successful tracheal resection is a definitive solution in comparison with stent placement.