Single-staged laryngotracheal resection and reconstruction for benign strictures in adults

Interact Cardiovasc Thorac Surg. 2008 Apr;7(2):227-30; discussion 230. doi: 10.1510/icvts.2007.168054. Epub 2008 Jan 23.

Abstract

Laryngotracheal stenosis (LTS) is a challenging problem, and its management is complex. This study evaluated both short- and long-term outcomes following laryngotracheal resection and anastomosis. Between 1994 and 2006, 37 patients underwent surgery for LTS. The cause of stenosis was post-intubation or post-tracheostomy injury in 28 cases and idiopathic in nine. Pearson's technique was used for anterolateral cricotracheal resection (n=23), and Grillo's technique of providing a posterior membranous tracheal flap was used in cases of circumferential stenosis (n=14). Since 1998, we have modified the techniques in 21 cases, using a continuous 4/0 polydioxanone suture for the posterior part of the anastomosis. No peri-operative mortality was recorded. Three (8.1%) patients developed major complications (two fistulae and one early stenosis) that required a second surgical look. We had 16 minor complications in 14 (37.8%) patients. The long-term results were excellent to satisfactory in 36 patients (97.3%) and unsatisfactory in one (2.7%). Single-staged laryngotracheal resection is a demanding operation, but can be performed successfully with acceptable morbidity in specialized centers. The continuous suture in the posterior part of the anastomosis simplifies the procedure without causing technique-related complications. In our experience, this procedure guaranteed excellent to satisfactory results in more than 90% of patients.

MeSH terms

  • Adult
  • Aged
  • Anastomosis, Surgical
  • Female
  • Follow-Up Studies
  • Humans
  • Laryngectomy* / adverse effects
  • Laryngostenosis / etiology
  • Laryngostenosis / surgery*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Suture Techniques
  • Time Factors
  • Tracheal Stenosis / etiology
  • Tracheal Stenosis / surgery*
  • Tracheotomy* / adverse effects
  • Treatment Outcome