Surgical approach to funnel-shaped congenital tracheal stenosis

Purpose: The aim of this study was to evaluate the results obtained by 2 di fferent techniques of tracheoplasty in the treatment of long-segment, funne l-shaped congenital tracheal stenosis (CTS) in 2 tertiary paediatric hospit als. Methods: The clinical records of patients with long segment congenital trac heal stenosis during the period January 1990 to June 1999 were reviewed ret rospectively. Age, gender, symptoms, imaging (x-ray, computed tomography, m agnetic resonance imaging, or bronchography), endoscopic findings, associat ed anomalies, treatment, intubation time, postoperative treatment, intensiv e care unit stay, complications, hospital stay, evolution, and follow-up ti me were analyzed. Short congenital tracheal stenosis treated by resection a nd end-to-end anastomosis are not included. Results are given as mean +/- S EM. Results: Ten (7 boys, 4 girls) of 14 patients with CTS had a funnel-shaped CTS. Mean age at treatment was 9.7 +/- 4.8 months (range, 3 days to 4.7 yea rs). All of the patients presented with CTS affecting the distal third of t he trachea and 4 of them extension to 1 main stem bronchus. They were treat ed by 2 different types of tracheoplasty: anterior costal cartilage graft ( ACGT, 6 patients) and slide tracheoplasty (ST, 4 patients). All the patient s treated by ACGT failed: 4 died and 2 required further surgery for resteno sis. Causes of death were acute respiratory failure during surgery (2 cases ) and anastomotic dehiscence (2 cases). The patients treated with ST are as ymptomatic and doing well. Mean postoperative intubation time of the ACGT g roup was 35 +/- 25 days (10 to 60 days), whereas in the ST group it was 14 +/- 12 days (0 to 51 days). Mean hospital stays were 292 +/- 271 days (21 t o 563 days) and 24 +/- 13 days (7 to 63 days), respectively. Mean follow-up time is 28 +/- 14 months (3 to 94 months). Conclusions: Surgery of long-segment congenital tracheal stenosis has a hig h failure and complication rate with vital implications in prognosis. Treat ment should be done in a multidisciplinary basis by a highly trained and mo tivated team. Slide tracheoplasty seems to be the better option, although f urther multicentre studies should be conducted. Copyright (C) 2001 by W.B. Saunders Company.