RECONSTRUCTION OF THE CARINA IN CHILDREN AND ADOLESCENTS

While resection of tracheobronchial segments has become a standard ope ration in adults, lesions of the carina in children are rare and their treatment is technically more demanding. Since 1980, 8 patients aged 8 to 19 years underwent surgical reconstruction of the carina. The ind ications were tumors in 5 and non-neoplastic lesions in 3. In 3 patien ts with tumor (2) and advanced histoplasmosis (1), resection of the ca rina was combined with parenchymal resection. The principles of operat ive repair include complete resection, with frozen section confirmatio n in tumors, particular emphasis on adequate mobilization of the airwa y in children to reduce anastomotic tension, and use of anesthetic tec hniques that facilitate early extubation. One patient (12.5%) died aft er complex airway reconstruction for extensive mediastinal fibrosis. R esidual malacia in a patient with postpneumonectomy syndrome required successful re-resection. Seven patients remain free of anastomotic str icture and tumor recurrence during a mean follow-up of 62 months (rang e 5 to 132 months), with expected preservation of lung function. Late bronchoscopy in 5 patients 6 months to 11 years after operation demons trated growth of the luminal diameter and patent anastomoses. Carinal reconstruction in children is occasionally required, succeeds in gener al, and does not result in late problems at the anastomosis.