Tracheal resection associated with slide tracheoplasty for long-segment congenital tracheal stenosis involving the carina

Surgical management of children presenting with surgical-needed tracheal stenosis

OBJECTIVES

The purpose of this work was to assess epidemiological aspects, surgical approach, morbidity and mortality rates of patients presenting with tracheal stenosis requiring surgery, and the evolution of surgical techniques over the last years.

METHODS

We performed a retrospective observational study from 1990 to 2017 in a pediatric tertiary-care center with needing surgery for tracheal stenosis. We analyzed clinical patients' characteristics, type of stenosis, type of surgery and follow-up.

RESULTS

Twenty-eight children presented with tracheal stenosis, half of them with congenital stenosis (complete tracheal rings) and the other half with acquired stenosis (neoplasic or post intubation injury). 39.3% of these stenoses were associated with a vascular ring (61.5% in case of congenital stenosis). Depending on the extent of the stenosis and its origin, the surgery could be performed endoscopically or by an external approach. Enlargement tracheoplasty with an autograft (14.3%) was replaced by slide tracheoplasty with Cardio Pulmonary By-Pass (CPBP, 28.6%) with improved results for the treatment of long segment tracheal stenosis, involving more than 30% of the tracheal length (all were congenital in our study). Slide tracheoplasty has been performed since the late 90's in our institution. 25% of children have had a resection and anastomosis of the trachea because they had a stenosis involving less than 30% of tracheal length. Endoscopic surgery was performed for membranous stenoses, which were often seen after intubation or tracheotomy (32.1% of patients).

CONCLUSION

Effective treatment of surgical tracheal stenosis was performed in 28 children between 1990 and 2015. Surgical techniques have evolved over time, leading to a better management of this rare and serious disease.

Virtual 3D Modeling of Airways in Congenital Heart Defects

The involvement of the airway is not uncommon in the presence of complex cardiovascular malformations. In these cases, a careful inspection of the relationship between the airway and the vasculature is paramount to plan the surgical procedure. Three-dimensional printing enhanced the visualization of the cardiovascular structure. Unfortunately, IT does not allow to remove selected anatomy to improve the visualization of the surrounding ones. Computerized modeling has the potential to fill this gap by allowing a dynamic handling of different anatomies, increasing the exposure of vessels or bronchi to show their relationship. We started to use this technique to plan the surgical repair in these complex cases where the airway is affected. This technique is routinely used in our Institution as an additional tool in the presurgical assessment. We report four cases in which the airways were compressed by vascular structures - ascending aorta in one, left pulmonary artery sling in one, patent ductus arteriosus in one, and major aorto-pulmonary collateral artery in one. We believe this technique can enhance the understanding of the causes of airway involvement and facilitate the creation of an appropriate surgical plan.

Laryngotracheale Stenosen im Kindesalter

BACKGROUND

Stenoses of the larynx and upper trachea in the pediatric population require a multidisciplinary approach and center-based treatment. Patterns of care and treatment strategies in Germany were evaluated using a standardized questionnaire.

MATERIAL AND METHODS

A questionnaire was transmitted by telefax to 141 departments of Otorhinolaryngology (ORL) and to 214 pediatric (PED) departments. Using primarily multiple-choice questions variables regarding caseload, surgical techniques, cooperating institutions, criteria for surgical indications and subjective assessment of success rates were investigated.

RESULTS

The response rate was 55% (ORL) and 46% (PED), respectively, 34% of the replying ORL departments were offering tracheal surgery in children, with most of them using advanced surgical techniques. In 12 ORL departments 1-3 cases per year were operated, in 6 ORL departments more than 6 cases per year and 3 ORL departments were perceived as specialized centers for pediatric airway surgery by their peers. However, 41% of the PED departments were unable to identify a center for pediatric airway surgery.

CONCLUSION

In Germany, surgery for pediatric airway stenoses is not primarily focused on treatment centers. There is a significant information gap among German pediatricians regarding success rates of reconstructive airway surgery and available centers offering surgical therapy for this population. Several factors offer potential to be optimized in the care for children with a compromised airway and improving communication between otolaryngologists and pediatricians should be a primary goal in the future.

Slide cricotracheoplasty: a novel surgical technique for congenital cricotracheal stenosis

PURPOSE

The aim of this study was to introduce a new surgical technique for the correction of congenital cricotracheal stenosis.

METHODS

A 5-day-old girl presented with esophageal atresia and congenital cricotracheal stenosis. After successfully correcting her esophageal atresia, the authors chose to use a type of slide cricotracheoplasty, which was a modification of slide tracheoplasty and anterior cricoid split.

RESULTS

The postoperative period was remarkably uneventful except for minor subcutaneous emphysema, and the midterm results were excellent.

CONCLUSIONS

Slide cricotracheoplasty produced a good result and offered the same advantages as slide tracheoplasty. The authors believe that the described technique offers an efficient surgical procedure for the single-staged correction of congenital cricotracheal stenosis.