[Endotracheal silicon stents in therapy management of benign tracheal stenoses]

External fixation of airway stents for upper tracheal stenosis and tracheoesophageal fistula

OBJECTIVES

Stent migration is a common complication of airway stent placement for upper tracheal stenosis and tracheoesophageal fistula. Although several researchers have reported that external fixation is effective in preventing stent migration, the usefulness and safety of external fixation have not been proved because their cohorts were small. We therefore investigated the efficacy and safety of external fixation during upper tracheal stenting.

METHODS

Records of patients who underwent airway stent placement from May 2007 to August 2018 in a single centre were retrospectively reviewed. We included only patients whose stent had been placed in the upper trachea with external fixation to the tracheal wall. The primary endpoint of this study was the rate of stent migration.

RESULTS

Altogether, 51 procedures were performed in 45 patients (32 males, 13 females; median age 60 years, range 14-91 years). The median follow-up period was 9 months (range 0.3-90 months). Among the procedures, 15 were performed for benign disease and 36 for malignancy. Stents were composed of either silicone (n = 42) or metal (n = 9). Stent migration occurred in 3 (6%) patients. The stents with migration were all composed of silicone. Other sequelae were granulation tissue formation in 10 (20%) patients, sputum obstruction in 6 (12%), cellulitis in 3 (6%) and pneumonia in 1 (2%).

CONCLUSIONS

External fixation was an effective method for preventing migration of airway stents placed for upper tracheal stenosis and tracheoesophageal fistula. The complications were acceptable in terms of safety.

The suction-assisted endoscopic suture technique: A simple method for endotracheal suturing

BACKGROUND

Silicone stents are commonly employed to treat subglottic stenosis. A frequent complication is the tendency of stents to migrate. As such, various techniques to secure stents have been developed over the years, none of which have gained large popularity. We present a novel, low-cost, and easy-to-perform technique herein.

OBJECTIVES

To describe a novel surgical technique to secure silicone stents and prevent migration for management of subglottic stenosis.

MATERIALS AND METHODS

After standard excision and dilation of stenotic portions in the subglottic or trachea. A silicone stent is introduced in a standard fashion. To secure the stent, an 18-G needle loaded with braided suture is inserted through skin, trachea, and stent. Endoscopic visualization then permits the surgeon to grasp the suture with forceps. A separate transcutaneous puncture site is performed with an 18-G needle attached to a 10-cc syringe (plunger removed) and blue tip suction within the empty syringe, creating an airtight suctioning tool. The grasped suture is gently introduced into the eye of the needle and quickly travels into the 10-cc syringe with suction assist, leaving both extracorporeal ends of the suture to tie.

RESULTS

This stitch has been employed on seven occasions on four patients. There have been no episodes of stent migration. A laboratory model found the 18-G needle and braided 3-0 suture performed optimally.

CONCLUSIONS

We present a novel surgical technique to secure silicone stents in management subglottic or tracheal stenosis.

LEVEL OF EVIDENCE

Level 4 Laryngoscope, 130:E346-E348, 2020.

Suture fixation of tracheal stents for the treatment of upper trachea stenosis: a retrospective study

Background

Stent migration is a common complication in treating trachea stenosis. There is no report concerning suture fixation of tracheal stent. The aim of this study was to investigate whether suture fixation of tracheal stent could avoid stent migration in patients with upper trachea stenosis. The complications were further investigated.

Methods

The patients with upper trachea stenosis who underwent tracheal stent placement for benign/malignant conditions in our hospital between May 2016 and April 2018 were retrospectively reviewed. Clinical data were collected for each patient, including age, gender, co-morbid diseases, site of tracheal obstruction, degree of tracheal obstruction, success of stent placement, impact on patient’s symptoms, complications, etc.

Results

Eleven patients (8 males and 3 females; range of age: 17–85, and average age of 63) were enrolled into this study. Six silicone stents and five membrane-covered metal stents were used. The surgery was successfully performed in all the cases. The postoperative recovery was uneventful. All symptoms of the patients were relieved. No complications occurred. The average follow-up for patients was 5 months (range of 1–13 months). During the follow-up, no stent migration was observed according to CT and bronchoscope.

Conclusion

The results suggested that suture fixation of stents could avoid stent migration in treating upper trachea stenosis with metal stent or silicone stent. This method seemed to be effective without operation complications.

Prise en charge chirurgicale et/ou endoscopique des sténoses trachéales acquises non tumorales de l’adulte

OBJECTIVES

Retrospective survey (over 13 Years) of the surgical treatment of 46 acquired tracheal stenosis, in adult patients. Our goals were to study their epidemiology, changes in the surgical technique with the cervical or endoscopic approach, and the recent contribution of endoprotheses.

MATERIALS AND METHODS

Sixty-six therapeutic procedures were performed for 46 tracheal stenoses. Most of stenoses were post-intubation and/or post-tracheotomy and were fixed in 50% of the cases. We used 21 sleeve resections with end-to-end anastomoses, 9 tracheal stents, 27 dilations, 6 calibrations, and 3 electro-coagulations.

RESULTS

The sleeve resection gave 91% success (1 failure and 1 death). The endoscopic treatments were less efficient: 79% for tracheal stents (2 mobilizations), 50% success for iterative dilations. The respiratory tests were meaningfully improved with a mean follow-up of 18 Months.

CONCLUSION

Sleeve resection remains the gold standard treatment. For all temporary or definitive contraindications to open surgery, tracheal stents would be an excellent alternative to avoid often inefficient iterative dilations.

Suspension laryngoscopy for endotracheal stenting

OBJECTIVES/HYPOTHESIS

Airway stents have recently been used to establish and maintain patent airways in patients with malignant central airway obstruction, but insertion modalities remain controversial to date. The study seeks to determine the role of suspension laryngoscopy in interdisciplinary airway stenting.

STUDY DESIGN

Retrospective, single-institution analysis of a case series treated by a multidisciplinary airway team.

METHODS

Ninety-three consecutive patients with malignant obstruction of the trachea and/or tracheobronchial bifurcation underwent endotracheal stenting through a suspension laryngoscopy approach for the relief of impending respiratory distress. Feasibility, mortality, survival, and complications were analyzed as main outcome measures.

RESULTS

Stenting through a suspension laryngoscopy approach was feasible 91 of 93 patients (97.8%). Fifteen patients needed repeated stenting, and in all, 121 stents were implanted during the observation period. This approach allowed for the repeated insertion of rigid bronchoscopes of graded sizes to establish an airway and for precise stent positioning. Optical instruments and stent introducer systems could easily be used while adequate ventilation was continuously maintained. Silicone stents of maximal size were inserted without injury of the vocal cords during intubation. Median survival for all patients was 8 months. No intraoperative airway complications were observed, and no patient died secondary to stenting.

CONCLUSIONS

Suspension laryngoscopy and jet ventilation provide an ideal setting for the precise placement of tracheal and bifurcation airway stents. Laryngologists should actively participate in interdisciplinary airway stenting programs.