Management of congenital tracheal stenosis in infancy☆

Abstract

Bronchoscopy is our preferred diagnostic tool. Selection of the type of treatment depends on the patient's clinical status and the anatomical pattern of the stenosis. In symptomatic cases with short-segment stenosis (<30% of total tracheal length), we prefer tracheal resection with end-to-end anastomosis; for long-segment stenosis (>30%), slide tracheoplasty is our procedure of choice.

Management of Congenital Tracheal Stenosis

“…The rarity and complexity of CTS demands a multidisciplinary therapeutic approach and individualized patient management. 4 Although a subset of infants with CTS may outgrow their tracheal stenosis over time, 2,5,6 surgical intervention is often inevitable for symptomatic patients. Several operative techniques for treating CTS have been described, including resection with end-to-end anastomosis, 7 rib cartilage graft tracheoplasty, 8,9 pericardial patch tracheoplasty, 5,7,10,11 and slide tracheoplasty.…”

“…4 Although a subset of infants with CTS may outgrow their tracheal stenosis over time, 2,5,6 surgical intervention is often inevitable for symptomatic patients. Several operative techniques for treating CTS have been described, including resection with end-to-end anastomosis, 7 rib cartilage graft tracheoplasty, 8,9 pericardial patch tracheoplasty, 5,7,10,11 and slide tracheoplasty. 4,5,7,[12][13][14][15][16][17] Additionally, the use of endoscopic stenting as the primary treatment of CTS was recently reported.…”

Operative or non-operative treatment of congenital tracheal stenosis: is there something new?

“…Nevertheless, most of the patients fall into clinical or functional groups II and III (3) and should be first stabilized, then a complete diagnostic work-up done and finally operated as soon as possible. All this clinical care pathway should ideally be performed in a referral center with a multidisciplinary approach (5).…”

“…Surgical procedures for CTS repair fall into three categories: (I) tracheal reconstruction with autologous tracheal tissue (tracheal resection, slide tracheoplasty, and free tracheal autograft); (II) tracheoplasty with nontracheal autologous tissue (costal cartilage or pericardial patch); and (III) tissue-engineered tracheal replacement (5). Surgical treatment of CTS has evolved considerably for the last two decades and slide tracheoplasty, on cardiopulmonary bypass, has emerged as the "gold standard" technique (2,5,9,10).…”

“…Surgical treatment of CTS has evolved considerably for the last two decades and slide tracheoplasty, on cardiopulmonary bypass, has emerged as the "gold standard" technique (2,5,9,10). Increasing experience with this procedure has dramatically improved the outcomes of CTS, in contrast to what Hong et al (1) describe in their article.…”