The etiological factors of recurrence after tracheal resection and reconstruction in post-intubation stenosis

Abstract

We assessed several factors which might be responsible for the recurrence of post-intubation airway stenosis in a large group of patients who underwent resection and reconstruction surgery by one surgical team. Four hundred and ninety-four patients underwent reconstruction of post-intubation airway stenosis during 1995-2006. The case group comprised patients who had developed recurrence, while controls had no recurrence. The diagnosis of the recurrence was made based on the presence of clinical signs or symptoms and bronchoscopic evaluation. The following variables were compared in both groups: age, sex, duration of intubation, reason for intubation, period of time between intubation and surgery, history of previous tracheotomy, previous therapeutic interventions, subglottic involvement, length of resection, presence of unusual tension at the site of anastomosis and anastomotic infection. Fifty-two patients (10.5%) developed recurrence. Lengthy resection, presence of tension at the site of anastomosis, anastomotic infection and subglottic involvement were significantly higher in the case group. Logistic regression model showed that the three main predictors are anastomotic infection (OR=3.44), subglottic involvement (OR=2.43), and presence of tension (OR=1.97), respectively. It is concluded that the surgeon can play an important role in avoiding recurrence by decreasing tension, preventing infection, and preserving subglottic structure.

Functional outcome after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis

“…This strengthens the notion that LTR is a more challenging and complex procedure with less predictable outcomes when compared to STR (6,14,15). This is probably due to the anatomical challenges in the laryngeal zone, caused by a very narrow tracheal lumen in this region, the attachment of the vocal cords to the arytenoids, as well as the branches of the RLN which are attached to the lateral sides of the cricoid.…”

Post Intubation Early and Late Tracheal Pathologies

“…Bunu azaltmak için yüksek volümlü ve düşük basınçlı kaf kullanımı savunulmaktadır [4,5]. Darlık gelişen olgular bir süre asemptomatik kalmaktadır (darlık %30'a ulaşana kadar) ama daha sonra balgam atmada güçlük, dispne ve darlık artmaya devam ederse stridor başlayabilir [4,6]. Spirometride PEF değerinde karakteristik bir azalma ve ekspirasyon eğrisinde plato görülür.…”

“…Abbasidezfouli ve ark. [6] rezeksiyon sonrası anastomoz yapılan 494 olgulu bir çalışmasında 57 (%10.5) olguda restenoz görmüşlerdir. Bu çalışmada entübasyonun nedeni, entübasyonun süresi, ilk entübasyonla cerrahi arasındaki sürenin restenozda etkili olmadığı gösterilmiş-tir.…”

ACE insertion/deletion polymorphism and restenosis events after coronary stent placement in East Azerbaijan Province of Iran

“…Coronary artery disease (CAD) and myocardial infarction (MI), is a complex disorder resulting from the interaction between genetic and environmental factors [1,2]. Percutaneous transluminal coronary angioplasty (PTCA) was introduced in 1979 [2].…”