Treatment strategies in the management of severe complications following slide tracheoplasty in children

Abstract

STP has become the procedure of choice when dealing with CTS. Although it shows clear advantages compared with other surgical techniques, severe and difficult to manage complications may occur. Surgeons involved in their treatment should be familiar with diverse surgical and endoscopical procedures. Biodegradable airway stenting is a new and promising technique when long and severe post-surgical tracheal stenosis is present.

ERS statement: interventional bronchoscopy in children

“…Balloon dilation has been used alone or with other techniques such as laser treatment [95][96][97], stent placement [98][99][100][101][102][103][104], mitomycin application [93], injection of intralesional corticosteroids [105] and by anaesthetists during VATS in children [106]. Serial balloon dilation has been used successfully to manage severe complications following slide tracheoplasty in children with congenital tracheal stenosis [97,104,105], to treat acquired tracheal [95,[107][108][109] or bronchial stenosis [110,111] and to treat stenosis due to granulation tissue after airway stenting [89].…”

“…Serial balloon dilation has been used successfully to manage severe complications following slide tracheoplasty in children with congenital tracheal stenosis [97,104,105], to treat acquired tracheal [95,[107][108][109] or bronchial stenosis [110,111] and to treat stenosis due to granulation tissue after airway stenting [89]. In addition, bronchoplasty by balloon dilation has been used to dilate the airway segment proximal to a foreign body to facilitate extraction [112,113].…”

Management of Congenital Tracheal Stenosis

“…18 Nevertheless, the utility of adjunctive tracheal stenting to manage residual stenosis postsurgical intervention has been widely demonstrated. 5,13,33,39,40 Indications for surgery are primarily based on functional status, 20 whereby any patient presenting with significant respiratory symptoms generally meets the criteria for operative intervention. Any combination of the following symptoms may be exhibited: persistent wheeze, dyspnea, repeated respiratory infections refractory to medical therapy, failure to wean from ventilator support, or unsuccessful ventilator support.…”

“…The standard of care for has evolved to an integrated, multidisciplinary team-based approach. 33,39 Multidisciplinary, team-based care…”

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

“…In most cases, stents are used as a life-saving procedure in extremely sick children. In CTS stents are generally used as a temporary measure after surgical reconstruction or in the management of postsurgical complications (7,18). Although some authors describe initial treatment of CTS with metallic stents (19,20), this approach is not shared by most tracheal teams (5,7,10,11).…”