Management of distal tracheal stenosis

Objective: To evaluate the treatment, perioperative management, and outcome of infants who underwent repair of congenital tracheal stenosis. We hypoth esized that early resection and tracheoplasty with early weaning of ventila tory support results in less mucosal injury, and thus better outcome. Design: Retrospective study from 1986 to 1996. Setting: Tertiary care children's hospital. Patients: Seventeen consecutive infants with congenital tracheal stenosis, aged from birth to 16 months. Fifteen patients had complete tracheal rings, 6 of whom also had a left pulmonary artery sling. Fourteen patients underw ent either tracheoplasty or resection and reanastomosis of the trachea, bot h facilitated by cardiopulmonary bypass. Results: Six patients underwent resection and reanastomosis; 4 patients wer e extubated within 2 to 5 days without sequelae. There was 1 unrelated peri operative death. Two patients required reintubation. Eight patients require d tracheoplasty due to severe tracheal stenosis and had variable postoperat ive courses. Seven of 14 patients required 0 to 1 postoperative bronchoscop ies. Seven of 14 patients required 2 to 7 bronchoscopies for granulation ti ssue formation, cicatrix, graft collapse, and tracheitis. One patient requi red numerous procedures and revision tracheoplasty for cicatrix and stenosi s. Conclusions: Correction of short-segment (<5 rings) tracheal stenosis by re section and reanastomosis of the trachea with the aid of cardiopulmonary by pass and early weaning of ventilatory support is recommended. Tracheoplasty using either the castellation technique or slide tracheoplasty is recommen ded in the treatment of infants with severe (long segment) tracheal stenosi s.