Stenting or Surgery in Benign Tracheal Stenosis?

Abstract

Background: Review of stenting in benign tracheal stenosis in the long run in comparison with surgical procedures concerning indications, tolerance of stents, efficacy, complications and follow up after removal, restenting and survival. Patients and material: In a 18 year period between July 1993 and June 2011 in tracheal stenoses 52 stents, (( 32 silicone, 12 dynamic bifurcated stents, 2 metallic covered stents, 6 t-tubes )) were inserted in 35 symptomatic patients (17 men, 18 women, age 12 till 96, mean 65,7 years, 1.3 stent per patient). Indications for stenting were: anatomic stenosis, stricture and compression, malacia and combined stenosis. Retrospective analysis was done with follow up till June 2011. Data collection: Data were provided by review of patients’ charts, interview of family doctors, external hospitals and in single cases interview of family members. Patients who came for controlling of the stent were also interviewed. Methods: Bronchoscopic procedure was done under general anaesthesia, intubation with a rigid bronchoscope, dilation by balloon, rigid scope or combination. Stent placement was mostly done under fluoroscopy. Stent removal and/or replacement were also done with a rigid bronchoscope under general anaesthesia. Only the procedures for placement of a Montgomery t-tube were done under local anaesthesia. Results: During the observation period the longest survival time so far was 18 years. In 19 patients the stent led to a relief of symptoms, mainly dyspnoea and stridor and was tolerated without major complications (Successful stenting). In 12 patients the stent had to be removed because of complications and another four patients died of stenting related complications. In 16 patients therefore stenting was called “not successful”. Conclusions: In comparison to patients with advanced malignant diseases, where stenting is supposed only palliative, patients with tracheo-bronchial diseases are not limited in their life expectancy from the local tracheal disease, if this can be treated. But often these patients are high risk patients concerning co-morbidities, technical and functional operability. In these patients a stent can therefore be an alternative to surgery. Nevertheless because of the high rate of complications, which can be also life threatening, the decision must be done carefully. Purpose: Review of stenting in benign tracheal stenosis in the long run concerning indications, tolerance of stents, efficacy, complications, follow up after removal, restenting and survival. Corresponding author: Hermann Tonn, Klinikum Region Hannover, Pneumology, Intensive Care and Sleep Medicine, Hannover, Germany, E-mail: hctonn@aol.com Received September 30, 2011; Accepted November 16, 2011; Published November 18, 2011 Citation: Tonn H (2011) Stenting or Surgery in Benign Tracheal Stenosis? J Pulmonar Respirat Med S3:002. doi:10.4172/2161-105X.S3-002 Copyright: © 2011 Tonn H. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Patients and Material In 18 year period between July 1993 and June 2011 a total of 385 tracheobronchial stents in 291 patients were inserted. 318 stents were used for malignant diseases, 67 in benign diseases [1-3]. In tracheal stenoses 52 stents, (32 silicone radiopaque Dumon stents (3 bifurcated) [4,5], 12 dynamic bifurcated Freitag stents [1], 2 metallic covered Ultraflex® stents [6], 6 Montgomery t-tubes [7] ) were inserted in 35 symptomatic patients (17 men, 18 women, age 12 till 96, mean 65,7 years, 1.3 stent per patient). Indications for stenting were: anatomic stenosis, stricture and compression, malacia and combined stenosis. Retrospective analysis was done with follow up till June 2011.