TRACHEAL RESECTION AND END-TO-END ANASTOMOSIS FOR TRACHEAL STENOSIS: ETIOLOGY AND OUTCOME

Abstract

Objective: To know the etiology of tracheal stenosis and assess outcome of tracheal resection & end-to-end anastomosis for tracheal stenosis.
Design: Descriptive prospective case series.
Place and Duration of Study: Department of Thoracic Surgery, Combined Military Hospital, Rawalpindi and Quetta from May 2005 to March 2010.
Patients and Methods: Twenty two patients were included in the study that underwent tracheal resection followed by primary tracheal reconstruction by same surgical team. Etiology was ascertained on the basis of available history and per-operative findings. End-to-end tracheal anastomosis was done using vicryl 3/0. Outcome of surgical technique was assessed using peak expiratory flow rate (PEFR) and flexible bronchoscopy.
Results: Twenty two patients were managed over a period of five years, of which 17 (77.3%) were male and 5(22.7%) females. Mean patient age was 27.31±9.61years. Seven (31.8%) patients had New York Heart Association grade (NYHA)-III and 15(68.2%) had NYHA grade-IV dyspnoea. Seventeen (77.3%) had stridor. All patients were already being managed by pulmonologists, ENT specialists or intensivists. Twelve (54.5%) had grade-V stenosis (91-100% luminal obstruction) and 9 (40.9%) had grade-IV stenosis (76-90% obstruction). Six (27.3%) patients had subglottic stenosis, 13 (59.1%) had cervical tracheal stenosis and 3(13.6%) had mediastinal tracheal stenosis. Six (27.3%) patients had partial cricoid resection followed by thyrotracheal anastomosis, 13(59.1%) patients underwent cervical tracheal anastomosis and 3 (13.6%) patients required mediastinal tracheal anastomosis. Patients were followed up post-operatively for the development of immediate and delayed complications. The follow up was carried out for a minimum period of 6 months to a maximum period of 2 years. Postoperative complications included neck pain, lung collapse, and superficial skin infection.
Conclusion: Tracheal resection with end-to-end anastomosis is a safe, reliable and permanent procedure for the treatment of tracheal stenosis.