Surgical treatment for patients with tracheal and subgllotic stenosis

Iatrogenic airway injury after endotracheal intubation and tracheotomy remains a serious clinical problem. In this study we reviewed post-intubation and traumatic tracheal stenosis in 47 patients with a special attention to the cause, hense surgical treatment of the stenosis was performed and the results compared with the literatures.

Since February 1995 through January 2005 a total of 47 patients with tracheal stenosis and subgllotic as a result of tracheostomy or intubation in a single institution, were explored in this study and examined for the outcomes of stenosis management. There were 39 tracheal and 8 infraglottic stenosis. Our management strategy for stenosis was end-to-end anastomosis, and cartilage graft tracheoplasty.

Our management strategy for treatment of tracheal stenosis with resection and end-to-end anastomosis was associated with good outcomes. Patients were treated by tracheal or partial laryngotracheal resection. The overall success rate was 93% with the complication rate of 18%. A second operation was required on 2 patients (4%).

Long term tracheal tubes or intubation tubes and poor quality material tubes were the most common causes of these respiratory strictures. Our current procedures of choice for tracheal stenosis is sleeve resection with end- to -end anastomosis for short- segment stenoses (up to six rings). Cartilaginous homograft was performed when the loss the cartilage limited to the anterior part of trachea. The most common late complication was the formation of the granulations at the suture line. Granulation tissues can usually be managed with Laser or bronchoscopic removal.