Surgical treatment of non-malignant laryngotracheal stenosis
- 418 Downloads
The objectives of this study were the following: (1) to analyze the results of surgical treatment of non-malignant subglottic laryngeal and tracheal stenosis, (2) to evaluate the feasibility and technical aspects of the video mediastinoscopy for the mobilization of the mediastinal trachea, (3) to evaluate the influence of the early internal condition of the anastomosis on the development of restenosis. From 1996 up to 2013, 75 patients aged 11–78 years underwent surgery for post-intubation/tracheostomy (71 patients), post-traumatic (3 patients), and idiopathic (1 patient) subglottic laryngeal and tracheal stenosis. Twenty-three (30.7 %) patients with subglottic laryngeal and upper tracheal stenosis underwent cricotracheal resection and thyrotracheal anastomosis (group A), while 52 (69.3 %) patients with tracheal stenosis underwent tracheal resection and cricotracheal or tracheotracheal anastomosis (group B). The length of the resected segment in patients of groups A and B was 28–55 (42 ± 11) mm and 18–65 (36 ± 14) mm, respectively, (p = 0.22). Perioperative complications within 30 days occurred in eight (34.8 %) patients of group A, and in six (11.5 %) patients of group B (p = 0.04). There was one intraoperative and one postoperative death on the third day due to heart failure. The excellent results were achieved in 63 (86.3 %), satisfactory in 8 (11.0 %), and unsatisfactory in 2 (2.7 %) patients. The incidence rate of perioperative complications is related to the location of the stenosis and the type of the resection and anastomosis. Video mediastinoscopy simplifies the mobilization of the mediastinal trachea, which allows for carrying out the anastomosis with minimal tension. Early internal abnormalities of the anastomosis predict its restenosis.
KeywordsLarynx Trachea Stenosis Resection Anastomosis Video mediastinoscopy Restenosis
- 7.Taha MS, Mostafa BE, Fahmy M, Ghaffar MK (2009) Ghany. Spiral CT virtual bronchoscopy with multiplanar reformatting in the evaluation of post-intubation tracheal stenosis: comparison between endoscopic, radiological and surgical findings. Eur Arch Otorhinolaryngol 266:863–866PubMedCrossRefGoogle Scholar
- 8.Morshed K, Trojanowska A, Szymanski M, Trojanowski P, Szymanska A, Smolen A, Drop A (2011) Evaluation of tracheal stenosis: comparison between computed tomography virtual tracheobronchoscopy with multiplanar reformatting, flexible tracheofiberoscopy and intra-operative findings. Eur Arch Otorhinolaryngol 268:591–597PubMedCentralPubMedCrossRefGoogle Scholar
- 10.Kirby T, Fell S (2002) Mediastinoscopy. In: Pearson FG, Cooper JD, Deslauries J, Ginsberg R, Hiebert C, Patterson GA, Urshel H (eds) Thoracic surgery, vol 1. Churchill Livingstone, New York, pp 98–103Google Scholar
- 11.De Leyn P, Lerut T (2005) Videomediastinoscopy. Multimed Man Cardiothorac Surg. doi: 10.1510/MMCTS.2004.000166