SURGERY FOR POSTINTUBATION TRACHEAL AND TRACHEOSUBGLOTTIC STENOTIC LESIONS

Postintubation tracheal stenosis is a recognized problem. Although its incidence has recently decreased, it is still a difficult complicatio n to treat. We have reviewed our experience with 10 patients with trac heal stenosis over the last five years between 1990 and 1995. There we re seven male and three female patients with an average age of 14.2+/- 4 years (range 6 to 48 years). Resection and reconstruction with prima ry anastomosis was performed in seven patients, while conservative tre atment with dilatation was performed in two patients. One patient refu sed surgery. Operations performed included resection of tracheocricoid segment with tracheothyroid anastomosis (N=3) and tracheal resection with end-to-end anastomosis (N=4). The resected airway segment ranged from 3 cm to 6 cm. In view of the intense inflammatory and fibrotic pr ocess in and around the stenotic segment, the practice of tracheostomy for the relief of postintubation acute tracheal obstruction should no t be taken lightly, as it adds not only to the severity of the inflamm atory process, but also increases the length of the tracheal segment t o he resected. Postoperatively, all patients were extubated; this was accomplished by the end of surgery in six patients, while the seventh patient was extubated three weeks later. There was no mortality in thi s series. When normal functional activity and airway patency were take n as two parameters to judge the outcome of surgery, results were good in six (86%) patients and satisfactory in one. These results support the validity of the one-stage reconstruction approach as one alternati ve for the treatment of postintubation tracheal and tracheosubglottic stenotic lesions.