Stenosis of Trachea Resection and End-to-End Anastomosis

Laryngotracheal obstruction complicating tracheostomy or endotracheal intubation with assisted respiration. A critical review.

“…The first of these should be chosen whenever possible (Miscall, McKittrick, Giordano, and Nolan, 1963;Belsey, 1950;Mathey et al, 1966;Deverall, 1967;Pearson et al, 1968;Grillo, 1969a;Jewsbury, 1969;James et al, 1970).…”

“…This is certainly true of posttracheostomy stenoses of a fibrous nature, for they are nearly always short, usually not exceeding 1-5 cm in length (Grillo, 1969a;Cooper and Grillo, 1967;James et al, 1970), and it is very unusual to have to remove more than 4 cm of the trachea. Such lengths can easily be achieved (Barclay, McSwan, and Welsh, 1957;Miscall et al, 1963). Difficulty may occasionally be experienced if stenoses are present at more than one site, or if failed reconstructive procedures have already been performed.…”

“…Gibson (1967) treated four stenoses primarily by staged skin-tube reconstruction. The stenoses were more than 2 cm long and were considered to be too long for resection and end-to-end anastomosis, but with adequate mobilization strictures much longer than this, up to 6 cm in length, can be repaired by this method (Miscall et al, 1963 ;Barclay et al, 1957). At the time of writing three of Gibson's four staged reconstructions had been completed with excellent results.…”

Tracheal stricture following tracheostomy

“…Miscall, McKittrick, Giordano, and Nolan (1963) describe the excision of a 4-cm. stricture with end-to-end reconstruction, though extensive mediastinal mobilization was necessary through a sternal-splitting incision.…”

Tracheal Resection and Mucociliary Clearance

“…More recently, investigators have reported that one of the limiting factors in determining success or failure was the tension at the suture line. l, 9,12,13 In dogs, primary anastomosis is 100% successful provided the suture line tension is below 1700 gm. l,13 In humans, defects requiring more than 30% resection (3)(4) cm) can be repaired end-to-end only after a procedure to decrease suture line tension, such as extreme neck f1.exion,2,15-IS substernal methods of pulmonary freeing,2,5,12,15-19 or laryngeal release 20-22 is performed.…”