Tracheal reconstruction under tension: an experimental study in sheep

Aims: Invasion of the trachea by thyroid cancer is a difficult problem. Cir cumferential resection and end-to-end reconstruction is the treatment of ch oice. The objective of our study was to investigate the effect of tension o n tracheal healing and stenosis formation, and to ascertain the maximum tol erable tension. Methods: Tracheal resections of 3, 6 and 9cm with end-to-end anastomosis we re performed on 25 sheep. The intraoperative force required for approximati on of the tracheal stumps was measured. Luminal stenosis was determined wit h the aid of computerized planimetry 1, 2, 4, 8 and 24 weeks post-operative ly. Results: A gradual increase of the stenosis rate occurred with increasing t ension on the anastomosis. Acceptable results were achieved in the majority of cases without release techniques or tension suture. Conclusions: Tracheal anastomosis under tension does not always lead to dis ruption or separation of the anastomosis. With the additional use of releas e manoeuvres and tension sutures, tracheal anastomosis under tension are po ssible without severe stenosis. The additional use of temporary stenting ne eds to be elucidated. (C) 2001 Harcourt Publishers Ltd.