SILICONE STENTS IN THE MANAGEMENT OF BENIGN TRACHEOBRONCHIAL STENOSES- TOLERANCE AND EARLY RESULTS IN 63 PATIENTS

Study objective: To assess tolerance and early results of Dumon silico ne stents inserted in patients with nonneoplastic airway obstruction. Design: Tracheobronchial stenting for palliative or curative restorati on of airway narrowing has been evaluated in a retrospective study. Se tting: Tertiary-referral teaching hospital. Patients: Between May 1991 and September 1994, 63 patients with a mean age of 52 years had endob ronchial silicone stent insertion for benign tracheal stenosis (82% se condary to intubation or tracheostomy injury). Lesions were pure fibro us stenosis in 25 patients and fibroinflammatory stenosis in 38, Prost heses were used for temporary stenting of the airway during 18 months in 48 patients in whom cure was expected and as a procedure for pallia tion in the remaining 15 patients. Interventions: In all cases, the Du mon tracheobronchial stent was implanted with the rigid bronchoscope u nder general anesthesia. Results: Five patients died (four from unrela ted causes); one was due to hypersecretion and airway obstruction at t he time of an emergency tracheostomy 20 days after stent insertion, Co mplications included migration of prostheses in 11 (17.5%) patients, g ranuloma formation in 4 (6.3%) patients, and airway obstruction due to heavy secretion in 4 (6.3%), In 48 patients who received silicone ste nts with curative expectations, removal of the device was accomplished in 21 patients, Therapy proved successful in 17 patients with a mean follow-up of 259+/-173 days and stenosis recurred in 4. In 16 patients , stents still remain for a mean period of 364+/-119 days, In the seri es of 15 patients in whom silicone stents were implanted for palliatio n, prostheses were placed permanently in 11 with a mean follow-up of 4 86+/-260 days. In the remaining four patients,vith tracheostomy, silic one stents were used after inability to expand the upper limb of the T -tube (two patients) or placed above the tracheostomy stoma to maintai n laryngotracheal patency and preserve phonation when a T-tube was poo rly tolerated (two patients). Conclusions: Silicone tracheobronchial s tents are effective in the maintenance of airway patency and are assoc iated with good tolerance and infrequent complications that are rarely life-threatening.