Urgent segmental resection as the primary strategy in management of benign tracheal stenosis. A single center experience in 164 consecutive cases
| Autor: | Martin Lucenic, Svetozar Harustiak, Miroslav Janik, Roman Benej, Ivan Majer, Tibor Krajc, Juraj Demian |
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| Rok vydání: | 2009 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty Time Factors Adolescent Fistula medicine.medical_treatment Tracheoesophageal fistula Anastomosis Young Adult Tracheostomy medicine Intubation Intratracheal Intubation Humans Thoracotomy Child Aged Retrospective Studies Aged 80 and over business.industry Anastomosis Surgical Stent Middle Aged Thoracic Surgical Procedures medicine.disease Sternotomy Surgery Tracheal Stenosis Treatment Outcome Chest Tubes Female Stents Radiology Segmental resection Cardiology and Cardiovascular Medicine business Tracheoesophageal Fistula |
| Zdroj: | Interactive cardiovascular and thoracic surgery. 9(6) |
| ISSN: | 1569-9285 |
| Popis: | The report is a retrospective review of 238 benign tracheal stenoses of various etiologies treated between 1995 and 2008. To show that urgent segmental resection has complication rates similar to elective resection and, therefore, preoperative dilation is not necessary, we analysed records of patients who underwent either standard segmental resections with anterolateral mediastinal tracheal mobilization, single-suture anastomosis and neck flexion; or insertion of T-tube with oval-shaped horizontal arm. Primary segmental resection was performed in 164 patients (68.9%), including 14 cases with concomitant tracheo-esophageal fistula (TEF). T-tube as an initial treatment suited 74 (31.1%) patients. We encountered two partial and one complete anastomotic disruptions following subglottic resections treated by T-tube insertion and costal cartilage tracheoplasty or permanent tracheostomy. Restenosis rate in segmental resection was 3.1%. No difference in complication rate between urgent and elective segmental resections was experienced. We treated a small number of patients by endotracheal stent insertion but the results were discouraging. Urgent segmental resection without prior rigid bronchoscopy dilation is our strategy of choice whenever possible. As an alternative to dilation we prefer temporary insertion of modified T-tube. Stand-alone endoluminal dilation and stenting has yet to prove its safety and long-term efficacy. |
| Databáze: | OpenAIRE |
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