Tracheal resection and reanastomosis in the neonatal period

Background/Purpose: Severe congenital tracheal stenosis is rare. Most of th ese can be managed conservatively before elective repair. Focal tracheal st enosis has been treated with resection of the involved trachea and primary reanastomosis in older infants. The authors found no reports of repair of t his lesion in neonates. Two patients are presented with severe respiratory failure on the first day of life that required extracorporeal life support (ECLS) who underwent successful tracheal resection and reanastomosis (TRR) during the first week of life. Methods: A retrospective review was conducted. Results: Both babies had severe pulmonary hypertension and carbon dioxide r etention despite maximal therapy and were placed on ECLS shortly after tran sfer. One had an isolated stenosis of the upper trachea, and the other had agenesis of the right lung, esophageal atresia with tracheo-esophageal fist ula, and a tracheal stenosis at the end of a short trachea with a long, nar row left bronchus. Both underwent diagnostic studies and had surgical repai r while on ECLS at day 3 and 7 of life without bleeding complications. They were weaned off ECLS 1 and 8 days after surgery. One patient was extubated and did well. The other was extubated transiently, but required a tracheos tomy because of left mainstem bronchomalacia. Both are alive and well at 18 and 38 months of age, with no narrowing of the repairs. Conclusion: In the setting of severe respiratory failure requiring ECLS sup port, TRR can be performed safely and successfully in the neonate with foca l tracheal stenosis. J Pediatr Surg 36:1262-1265. Copyright (C) 2001 by W.B . Saunders Company.