Failed paediatric laryngotracheoplasty

Introduction: Clinical experience with the surgical treatment of paediatric laryngeal stenosis is decreasing, and therefore it is important to highlig ht the factors that may contribute to failure. Method: Retrospective study of 28 children undergoing laryngotracheoplasty (LTP) for laryngeal stenosis was carried out over an 11-year period. Results: Twenty-one patients were decannulated after their initial surgery. One child died prior to stent removal, and the initial surgery was unsucce ssful in six patients. Four of these underwent a second LTP. Three addition al patients were decannulated, including one patient following endoscopic s urgery only. One child is waiting decannulation, one child has not undergon e further surgery, and another has undergone multiple failed LTP and remain s dependent on the tracheostomy. Conclusions: Factors identified as contributing to surgical failure in this series included severity of stenosis, cause of stenosis, presence of gastr o-oesophageal reflux, other airway abnormalities, timing of surgery, type o f surgery employed, and factors related to postoperative management.