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Pitfalls in the management of congenital tracheal stenosis: is conservative management feasible?

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Abstract

Purpose

Congenital tracheal stenosis (CTS) is rare and challenging. Complete tracheal rings cause a wide spectrum of airway-obstructing lesions and varying degrees of respiratory distress. Although surgical reconstruction is the primary option for symptomatic CTS, sometimes an appropriate management strategy may be difficult due to other anomalies. We aimed to identify pitfalls in the management of CTS.

Methods

We retrospectively reviewed the records of patients with CTS during the last 10 years in our institution.

Results

Sixteen pediatric patients were diagnosed with CTS. Of the 16 patients, 12 (75.0%) had cardiovascular anomalies including seven left pulmonary artery sling. Six patients with dyspnoea caused by CTS and three patients with difficult intubations due to CTS underwent tracheoplasty. Four patients underwent only cardiovascular surgery without tracheoplasty. Three asymptomatic patients were followed up without undergoing any surgical procedure. We repeatedly discussed management of four patients with especially complex pathophysiology at multidisciplinary meetings. Right ventricular outflow tract obstruction, tracheobronchial malacia, increased pulmonary blood flow, and pulmonary aspiration due to gastroesophageal reflux presumably accounted for their severe respiratory distress, and we forewent their tracheal reconstruction.

Conclusion

The management of CTS should be individualized, and conservative management is a feasible option in selected cases.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Jichi Children’s Medical Center Tochigi, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan

    Yoshiko Usui, Shigeru Ono, Katsuhisa Baba & Yuki Tsuji

Authors
  1. Yoshiko Usui
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  2. Shigeru Ono
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  3. Katsuhisa Baba
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  4. Yuki Tsuji
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Corresponding author

Correspondence to Shigeru Ono.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the ethics committee of Jichi Medical University and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Usui, Y., Ono, S., Baba, K. et al. Pitfalls in the management of congenital tracheal stenosis: is conservative management feasible?. Pediatr Surg Int 34, 1035–1040 (2018). https://doi.org/10.1007/s00383-018-4329-y

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  • DOI: https://doi.org/10.1007/s00383-018-4329-y

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