Tracheal Stenosis Our Experience at a Tertiary Ca

Authors: Satish Nair Sharad Mohan Ghanashyam Mandal Ajith Nilakantan

Publish Date: 2013/06/15

Volume: 66, Issue: 1, Pages: 51-56

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Abstract

Tracheal stenosis TS a challenging problem is a known complication of prolonged intubation and tracheostomy The management involves a multidisciplinary approach with multiple complex procedures In this study we discuss our experience with severe TS with regards to patient characteristics cause and management A retrospective analysis of 20 patients of severe TS treated at a tertiary care centre was evaluated Inclusion criteria were all patients with severe TS who required surgical intervention Exclusion criteria were patients with associated laryngeal stenosis and TS due to cancer Demographic data was recorded and findings relating to aetiology characteristics of stenosis and the various aspects of therapeutic procedures performed are discussed with review of literature Descriptive analysis of data were performed SPSS 18 Results of the 20 patients 17 patients 85  developed TS post tracheostomy or post intubation and subsequent tracheostomy 13 Patients 65  had true stenosis of which 7 patients 35  had simple web or circumferential fibrosis and 6 patients 30  had complex stenosis Seven patients 35  had granulations causing severe TS which were mostly suprastomal 5 patients stomal 5 patients and combined stomal and suprastomal 3 patients The average length of stenosis was 357 cm 05–8 cm Montgomery t tube insertion was a common procedure in 18 patients 90  pre or post intervention Each patient underwent an average of 34 procedures during their course of treatment which included rigid bronchoscopy and mechanical debulking Nd YAG laser KTP laser balloon dilatation and use of stents Among the 7 patients with granulations 100  successful decanulation was noted with endoscopic management whereas in 13 patients with true stenosis 10 patients 769  required open surgical management 8 tracheal resection and anastomosis and 2 tracheoplasty with 80  successful decanulation 2 patients 154  were treated with endoscopy with 100  successful decanulation and 1 patient 77  was a non surgical candidate on stent Of the total 20 patients with severe TS in this series 17 85  of patients who were decanulated asymptomatic on routine daily activities with normal FFB were considered cured TS is a challenging condition requiring a highly skilled multidisciplinary team for adequate management Prolonged intubation and tracheostomy are the common causes leading to tracheal stenosis Simple tracheal stenosis is easier to manage than a complex stenosis which usually requires an open surgical procedure for successful management Presence of conditions like tracheoesophageal fistula and long segment tracheomalacia are poor factors for successful management In our cases successful decanulation was possible in 85  of the patients following a systematic multidisciplinary approach

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