Endoscopic and Surgical Treatment of Benign Tracheal Stenosis: A Multidisciplinary Team Approach

Özdemir, Cengiz; Kocatürk, Celalettin; Sökücü, Sinem Nedime; Sezen, Celal Buğra; Kutluk, Ali Cevat; Bilen, Salih; Dalar, Levent

doi:10.5761/atcs.oa.18-00073

Cited by 32 publications

(22 citation statements)

References 28 publications

(42 reference statements)

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“…As the anastomosis technique; interrupted sutures were used in the anterior wall in all patients, while the ratio of interrupted to continuous suture use in the membranous wall was 36%/64%, respectively. Anastomotic complications are detected during routine bronchoscopic examinations [21]. Wright et al stated that the best option for the treatment of restenosis is the T-tube or tracheostomy tube because it does not impair airway humidification and allows phonation [17].…”

Section: Discussionmentioning

confidence: 99%

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Prognostic factors associated with morbidity and mortality after surgery for postintubation tracheal stenosis

Ceritoğlu¹,

Sezen²,

Aker³

et al. 2020

Curr Thorac Surg

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To cite this article: Ceritoğlu A, Sezen CB, Aker C, Girgin O, Akın H. Prognostic factors associated with morbidity and mortality after surgery for postintubation tracheal stenosis. Curr Thorac Surg 2020; 5(1): 16-22. ABSTRACT Background:In this study, we reviewed the treatment, follow-up, and prognostic factors associated with complications in patients who underwent tracheal resection due to postintubation tracheal stenosis (PETS), in light of the literature. Materials and Methods: Twenty-five patients who were operated for PETS between June 2012 and June 2017 were retrospectively evaluated. The patients' postoperative complications and prognostic factors affecting mortality were examined.Results: There was 11 female (44%) and 14 male (56%) patients. Eight patients (32%) had comorbidities.The mean prolonged intubation time was 47.4 ± 55.0 minutes. Eight patients (32%) developed postoperative morbidity. The main prognostic factors associated with morbidity were the length of the stenotic area and the presence of endocrine and respiratory comorbidities (p<0.05). Tracheal fistulae were observed in 2 patients. The postoperative mortality rate was 8% (n=2). One patient with fistula died on postoperative day 2, while another patient died at postoperative three months due to cardiac failure. No significant factor was identified in relation to the development of tracheal fistulae. Conclusions:The most important factor associated with complications was the presence of endocrine comorbidities. Although tracheal surgery results in high rates of postoperative morbidity and mortality, we believe these risks can be reduced by experienced surgeons and appropriate patient selection.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Prognostic factors associated with morbidity and mortality after surgery for postintubation tracheal stenosis

Ceritoğlu¹,

Sezen²,

Aker³

et al. 2020

Curr Thorac Surg

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“…La frecuencia de ET posintubación varía del 0,6 % al 21 %. 6 Es una causa poco común de estridor y dificultad respiratoria en pediatría. La lesión se produce, generalmente, en la zona que está en contacto con el balón del tubo endotraqueal por necrosis isquémica.…”

Section: Discussionunclassified

“…: dilatación rígida o con balón, incisión con láser) tiene un rol limitado en el manejo de la ET debido a la alta tasa de recurrencia (del 90 % en las estenosis con afectación cartilaginosa). 6 Es de utilidad para aliviar los síntomas hasta el momento de la cirugía y puede ser una alternativa en los pacientes que no son candidatos a cirugía (comorbilidades), en la recurrencia poscirugía y en la estenosis simple (limitada a la mucosa, sin compromiso cartilaginoso ni malacia) en la que puede ser curativa (del 60 % al 100 %). 3,[5][6][7] La colocación de una prótesis endoluminal (stent) debe ser considerada como una solución temporal o como último recurso en la estenosis benigna.…”

Section: Discussionunclassified

“…La resección traqueal con anastomosis término-terminal (RT-TT) es el tratamiento de elección de la ET posintubación. [5][6][7] La longitud de la ET es el factor determinante más importante de la resecabilidad. 8 Existe consenso en que las estenosis menores del 50 % de la longitud traqueal se pueden tratar con resección y anastomosis primaria, mientras que, cuando la estenosis involucra más del 50 % (estenosis larga), es necesaria la traqueoplastía por deslizamiento.…”

Section: Introductionunclassified

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Tratamiento quirúrgico de la estenosis traqueal adquirida en pediatría

et al. 2020

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Presentación de casos clínicos RESUMEN La estenosis traqueal adquirida es muy poco frecuente en la edad pediátrica y puede responder a múltiples causas; la estenosis posintubación y la secundaria a traqueotomía son las más comunes. El manejo de la estenosis traqueal adquirida sigue siendo controvertido. El tratamiento endoscópico proporciona el alivio inmediato de los síntomas, pero se asocia a una alta tasa de recurrencia, y el uso de prótesis endoluminales puede incrementar la longitud de la estenosis y complicar una cirugía futura. Por el contrario, se han documentado buenos resultados a largo plazo con la resección traqueal con anastomosis primaria. Se describe nuestra experiencia con la resección traqueal con anastomosis término-terminal para el tratamiento de la estenosis traqueal posintubación en 8 pacientes.

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Stenting versus balloon dilatation in patients with tracheal benign stenosis: The STROBE trial

Marchioni

Andrisani

Tonelli

et al. 2022

Laryngoscope Investig Oto

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Background: It is well known that benign tracheal stenosis represents an obstacle to open surgery, and that its treatment could be challenging. Two endoscopic techniques have so far been adopted to restore tracheal patency: balloon dilatation (BA) through laryngoscopy, and tracheal stenting (ST) with rigid bronchoscopy. The main objective of this study was to compare the efficacy of BA and ST to treat benign tracheal stenosis not eligible for surgery.We also compared the rate of adverse events in the two treatment groups.Methods: A retrospective, observational cohort study was carried out at the University Hospital of Modena (Italy) from November 2012 to November 2017 in two separate departments. Patients were considered to be "stabilized" (primary outcome) if they did not report significant respiratory symptoms, or restenosis in the long-term (2 years) following the endoscopic procedure.Results: Sixty-six patients were included in the study (33 in the BA and 33 in the ST group, respectively). Unadjusted Kaplan-Meier estimates showed a greater therapeutic effect of ST compared to BA at 2 years (hazard ratio = 3.9 95%CI [1.5-9.8], p = .01).After adjusting for confounders, stratified analyses showed that this effect was significant in patients with complex stenosis, idiopathic etiology, and degree of stenosis >70%. Compared with BA, ST showed a higher rate of adverse events (p = .01).Conclusions: Compared to BA, ST seems to be more effective in achieving stabilization of tracheal patency in complex benign tracheal stenosis, although burdened with a significantly higher number of adverse effects. These findings warrant future prospective study for confirmation.Level of evidence: 3.

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Endoscopic and Surgical Treatment of Benign Tracheal Stenosis: A Multidisciplinary Team Approach

Abstract: Bronchoscopic methods are associated with a lower cure rate compared to surgery. A multidisciplinary approach was helpful for treatment planning in patients with PITS.

Cited by 32 publications

References 28 publications

Prognostic factors associated with morbidity and mortality after surgery for postintubation tracheal stenosis

Prognostic factors associated with morbidity and mortality after surgery for postintubation tracheal stenosis

Tratamiento quirúrgico de la estenosis traqueal adquirida en pediatría

Stenting versus balloon dilatation in patients with tracheal benign stenosis: The STROBE trial

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