TRACHEOPLASTY IN CONGENITAL TRACHEAL STENOSIS

Congenital tracheal stenosis is an uncommon but life-threatening condi tion whose management is still debated. The rarity of this disease exp lains the lack of a standard management. Between 1986 and 1996, eight children younger than 1 year were referred to our Institution with a t racheal stenosis. The median age at operation was 3.15 months and the median weight was 4.5 kg. The diagnosis was made after an episode of r espiratory distress in all but one and was confirmed by fiberoptic bro nchoscopy. The median length of tracheal stenosis was 24.5 mm (Ranges: 4-30 mm). Only one patient was free from associated cardiovascular de fect. Tracheal repair was performed under cardiopulmonary bypass in al l. In three it was achieved by pericardial augmentation of the stenose d area, in four by resection and end to end anastomosis and in one by sliding tracheoplasty. Concomitant cardiac repair was performed in six . Two patients died after pericardial patch augmentation. In both, dea th was related to profound hypoxemia due to patch collapse. Two patien ts developed restenosis after resection and end to end anastomosis. Th ey both had stent placement and one required reoperation and underwent a sliding tracheoplasty. At a median follow-up of 21 months (Ranges: 6-120) all the survivors are doing well and are free from respiratory symptoms. Bronchoscopic evaluation revealed in all a widely patent ana stomosis without restenosis. In conclusion, tracheal stenosis in child ren remains a challenging lesion. Surgical technique, whether resectio n and end to end anastomosis or sliding tracheoplasty offer better res ults and should be discussed according to the length of the stenosis. Pericardial plasty should be used with caution. (C) Published by Elsev ier Science Ireland Ltd. All rights reserved.