1
|
Genden EM, Chen YW. Tracheal transplantation: lessons learned that may apply to lung transplantation. Curr Opin Organ Transplant 2024:00075200-990000000-00144. [PMID: 39422597 DOI: 10.1097/mot.0000000000001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to explore the lessons learned from experimental and human tracheal transplantation to determine if this information may be applied to lung transplantation. RECENT FINDINGS Experimental work in animal models and the recent human tracheal transplantation suggests that a robust tracheal vascular supply prevents anastomotic complications. Further, this work demonstrates that tracheal allografts undergo a progressive chimerism as recipient epithelium repopulates the allograft. In contrast to most vascularized composite allografts such as hand and face transplantation that experience high rates of rejection, the tracheal allograft did not demonstrate rejection. This may suggest that tissue chimerism plays a role in evading immune-mediated allograft rejection. SUMMARY While anastomotic complications and chronic allograft rejection are the most common complications related to lung transplantation, the findings associated with tracheal transplantation may have implications for both reducing complications associated with lung transplantation.
Collapse
Affiliation(s)
- Eric M Genden
- Department of Otolaryngology-Head and Neck Surgery, Department of Neurosurgery, Department of Immunology and Immunotherapy, The Icahn School of Medicine at Mount Sinai
| | - Ya-Wen Chen
- Institute for Airway Sciences, Co-Scientific Director, Center for Epithelial and Airway Biology and Regeneration, Basic Science Research, Otolaryngology, Director, Developmental Origins of Health and Disease, Department of Otolaryngology, Department of Cell, Developmental and Regenerative Biology, Department of Pathology, Molecular and Cell Based Medicine, Black Family Stem Cell Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
2
|
Sahin MF, Beyoglu MA, Yazicioglu A, Yekeler E. Analysis of 40 patients who underwent tracheal resection due to benign complex tracheal stenosis. Asian J Surg 2021; 45:213-219. [PMID: 34052083 DOI: 10.1016/j.asjsur.2021.04.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/19/2021] [Accepted: 04/29/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Benign tracheal stenosis is a common complication in patients followed up in intensive care units. We aimed to analyze the etiology, diagnostic approaches, treatment methods for benign tracheal stenosis, and the predicting factors for complications after tracheal resection for benign stenosis. MATERIAL-METHOD Forty patients who underwent tracheal resection reconstruction due to benign tracheal stenosis were analyzed retrospectively. Predictive factors for complications were determined by statistical analysis. RESULTS There were 23 patients (57.5%) in the intubation group, 11 patients (27.5%) in the tracheostomy group, and 6 patients (15%) in the subsequent tracheostomy group. Preoperatively, rigid dilatation was applied to all patients between 2 and 6 sessions (median = 3). Tracheal resections were performed in all patients after rigid dilatations. The mean of the resected segment lengths is 32.1 ± 8.8 mm. There was a statistically significant difference between preoperative bronchoscopic measurements, preoperative tomography measurements, and intraoperative measurements of the stenosis segment (ꭓ2 (2) = 71,500; p < 0.001). The patients' mean follow-up period was 27.4 ± 21.7 months (3-84). Mortality due to tracheal surgery and major anastomotic complications were not observed. The minor anastomotic complication rate was 12.5%, the non-anastomotic complication rate was 17.5%. The effect of resection length and surgical experience were found to be statistically significant risk factors for anastomotic complications. CONCLUSIONS Rigid dilatation does not provide significant palliation in complex stenosis. Bronchoscopic measurements give closer results than CT measurements in the preoperative estimation of resection length. The risk of anastomotic complications increases when the length of the resection increases and when the surgical experience is less.
Collapse
Affiliation(s)
- Mehmet Furkan Sahin
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.
| | - Muhammet Ali Beyoglu
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.
| | - Alkin Yazicioglu
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.
| | - Erdal Yekeler
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.
| |
Collapse
|
3
|
Parshin VD, Rusakov MA, Berikkhanov ZG, Simonova MS, Ursov MA. [Assessment of tracheal elasticity and tracheal anastomosis tension in cicatricial stenosis]. Khirurgiia (Mosk) 2021:32-39. [PMID: 33570352 DOI: 10.17116/hirurgia202102132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the tracheal elasticity and tracheal anastomosis tension for prevention of anastomosis-related complications and estimation of the maximum length of resection. MATERIAL AND METHODS At the first stage, 20 patients with cicatricial tracheal stenosis underwent tracheoscopy in usual position, under maximum flexion and extension of the head for the period from September 2017 to December 2019. We measured the total length of trachea and length of stenotic segment. Tracheal extensibility was assessed considering the difference in measurements. At the second stage, anastomosis tension was intraoperatively measured using a dynamometer in normal head position, as well as at maximum flexion in 22 patients who underwent tracheal resection. Unlike multiple other studies, we studied tissue tension intraoperatively. RESULTS Mean length of trachea was 12.8 cm, extensibility - 1.3 cm. Tracheal elasticity was greater in patients with a longer trachea and in patients under 40 years old. Mean length of resection was 3.9 cm (30% of mean length of trachea), anastomosis tension - 2.7 H or 270 g. Head flexion was followed by tension decrease by 0.7 H (26.9%), i.e. 70 g. This approach is less effective in case of resection of more than 30% of trachea length in a particular patient. CONCLUSION Further experience in measurement of tracheal extensibility and anastomosis tension will make it possible to establish clinical significance of these indicators for prevention of complications.
Collapse
Affiliation(s)
- V D Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M A Rusakov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - Z G Berikkhanov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M S Simonova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M A Ursov
- Sechenov First Moscow State Medical University, Moscow, Russia
| |
Collapse
|
4
|
Nauta A, Mitilian D, Hanna A, Mercier O, Crutu A, Fabre D, Fadel E. Long-term Results and Functional Outcomes After Surgical Repair of Benign Laryngotracheal Stenosis. Ann Thorac Surg 2020; 111:1834-1841. [PMID: 33035455 DOI: 10.1016/j.athoracsur.2020.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/06/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Laryngotracheal resection and anastomosis (LTRA) is a reliable treatment for benign subglottic laryngotracheal stenosis (BSLTS), but data on functional outcomes are scarce. We assessed the surgical and functional outcomes of LTRA in BSLTS. METHODS We retrospectively reviewed consecutive patients who underwent LTRA for BSLTS in 2007 to 2018. The 30-day outcomes were mortality, complications, and success rate. At the last follow-up, patients completed functional questionnaires (visual analog scale [VAS] and modified Medical Research Council scale for dyspnea, a VAS for swallowing, and the Voice Handicap Index) and assessed quality of life. RESULTS Of 43 patients with BSLTS, 28 underwent the modified Pearson technique, and 15 Grillo's procedure. During the first 30 days, no patients died, the postoperative complication rate was 44%, and the success rate was 95%. After a mean follow-up of 53 months in 38 patients (88%), 7 patients had restenosis and 36 had late surgical success (95%). In the 34 patients who completed the questionnaires (79%), mean VAS dyspnea scores decreased significantly during rest (-5.4 ± 4.2) and exercise (-5.6 ± 4.4) (P < .001). A trend toward a decrease in modified Medical Research Council scale was found (P = .057; grade 0 in 62% of patients). The Voice Handicap Index indicated that voice impairment was absent to moderate in 30 patients (88%) and severe in 4 (12%). The VAS dysphagia scores were not significantly different before and after surgery. Quality of life gains were reported by 85% of patients. CONCLUSIONS Laryngotracheal resection and anastomosis for BSLTS is safe and provides excellent surgical and functional outcomes with an improved quality of life. Laryngotracheal resection and anastomosis is a valid treatment option for BSLTS.
Collapse
Affiliation(s)
- Anapa Nauta
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - Delphine Mitilian
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - Amir Hanna
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - Olaf Mercier
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - Adrian Crutu
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - Dominique Fabre
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - Elie Fadel
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France.
| |
Collapse
|
5
|
Starostin AV, Berikkhanov ZG, Parshin AV, Amangeldiev DM. [Etiology, diagnosis and treatment of cicatricial tracheal stenosis]. Khirurgiia (Mosk) 2020:53-60. [PMID: 32352669 DOI: 10.17116/hirurgia202004153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Development of tracheal surgery was associated with introduction of fundamentally new procedures: two-level reconstruction, redo tracheal resection, tracheal resection with simultaneous dissection of tracheoesophageal fistula. There are combined and staged techniques when tracheal repair or endoscopic interventions are performed as a stage before circular resection of trachea. However, a single algorithm for prevention and correction of postoperative complications is still absent in tracheal surgery. Further development of tracheal surgery directly depends on introduction of preventive measures and analysis of adverse factors associated with increased risk of complications. In this regard, ongoing researches in this area are very perspective.
Collapse
Affiliation(s)
- A V Starostin
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - Z G Berikkhanov
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - A V Parshin
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - D M Amangeldiev
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
| |
Collapse
|
6
|
Fiz I, Monnier P, Koelmel JC, Di Dio D, Fiz F, Missale F, Piazza C, Peretti G, Sittel C. Multicentric study applying the european laryngological society classification of benign laryngotracheal stenosis in adults treated by tracheal or cricotracheal resection and anastomosis. Laryngoscope 2019; 130:1640-1645. [PMID: 31508817 DOI: 10.1002/lary.28274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/06/2019] [Accepted: 08/16/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Introduction and widespread use of cricotracheal resection and anastomosis (CTRA) as routine treatment for high-grade benign laryngotracheal stenosis (LTS) led to the need for a new classification system that could accurately predict surgical outcomes by integrating crucial stenosis and patient-related information. In 2015, the European Laryngological Society (ELS) proposed a new classification for benign LTS. We retrospectively tested it in adults treated at three referral centers to assess its reliability in predicting surgical outcomes. STUDY DESIGN Retrospective cohort study. METHODS We included 166 adults treated by open tracheal resection and anastomosis (TRA) and CTRA procedures, restaged according to the ELS classification evaluating grade of stenosis (I-IV, Myer-Cotton), number of subsites involved, and presence of systemic comorbidities. We correlated these parameters with decannulation, number of retreatments, and complications. RESULTS Final decannulation was predicted by a proposed ELS score ≥ IIIb, history of previous treatment, and length of resection (P < .05). Decannulation was achieved in 99% of patients without and in 88% of patients with surgical complications (P < .01). The incidence of surgical complications was related to the proposed ELS score (P < .01); an ELS score < IIIb showed a lower complication rate compared to patients with a ≥ IIIb score (32.8% vs. 57.7%, P < .01). Additional treatment was required in 73 (44%) patients (mean = 2.7 ± 2.2, range = 1-11). ELS score ≥ IIIb, length of resection, and occurrence of surgical complications predicted the number of such treatments (P < .05, P < .05, and P < .001, respectively). CONCLUSIONS ELS classification of benign LTS is able to accurately predict success in adult TRA/CTRA procedures and may be helpful in choice of therapy and patient counseling. LEVEL OF EVIDENCE 2b Laryngoscope, 130:1640-1645, 2020.
Collapse
Affiliation(s)
- Ivana Fiz
- Department of Otorhinolaryngology-Head and Neck Surgery, Stuttgart Hospital, Stuttgart, Germany
| | - Philippe Monnier
- Department of Otolaryngology-Head and Neck Surgery, University Hospital, Vaud University Hospital Center, Lausanne, Switzerland
| | - Jan C Koelmel
- Department of Otorhinolaryngology-Head and Neck Surgery, Stuttgart Hospital, Stuttgart, Germany
| | - Diana Di Dio
- Department of Otorhinolaryngology-Head and Neck Surgery, Stuttgart Hospital, Stuttgart, Germany
| | - Francesco Fiz
- Nuclear Medicine Unit, Department of Radiology, University of Tuebingen, Tuebingen, Germany
| | - Francesco Missale
- Departement of Internal Medicine, University of Genoa, Genoa, Italy.,Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Scientific Institute for Research and Healthcare Foundation, National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Giorgio Peretti
- Departement of Internal Medicine, University of Genoa, Genoa, Italy.,Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Christian Sittel
- Department of Otorhinolaryngology-Head and Neck Surgery, Stuttgart Hospital, Stuttgart, Germany
| |
Collapse
|
7
|
Abstract
Tracheal resections are major surgical procedures with a complication rate as high as 44%. Early detection of complications followed by a structured and expedited course of action is critical for achieving a successful outcome. The prevention of complications after tracheal resection starts with a correct indication for resection. A thorough preoperative evaluation, meticulous surgical technique, and good postoperative care in a center that performs airway surgery routinely are important factors for achieving good results.
Collapse
|
8
|
Parshin VD, Rusakov MA, Parshin VV, Titov VA, Parshin AV, Starostin AV. [Tracheolaryngeal resection for cicatricle stenosis]. Khirurgiia (Mosk) 2018:41-48. [PMID: 29953099 DOI: 10.17116/hirurgia2018641-48] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To determine the safest and the most effective surgical treatment of patients with cicatricle stenosis of tracheolaryngeal segment via analysis of different approaches. MATERIAL AND METHODS For the period 1963-2015 at Petrovsky Russian Research Center for Surgery and Sechenov First Moscow State Medical University 1128 patients with cicatricle tracheal stenosis have been treated. There were 683 men and 445 women. 684 (60.6%) patients were young and the most employable (21-50 years). All patients were divided into 2 groups depending on time of treatment: the first one included 297 patients between 1963 and 2000, the second group - 831 patients between 2001 and 2015. In group 1 tracheolaryngeal anastomosis was made in 10 (16.9%) out of 59 patients who underwent tracheal resection. Previously indication for this surgery was cicatricle stenosis of cervical trachea and larynx with upper borderline of cicatricle changes at least 2 cm from vocal folds. In group 2 these procedures were more frequent. 94 (28.5%) out of 330 patients underwent tracheolaryngeal resection. Cranial borderline of lesion was within 0.5 cm from the vocal folds (only if posterior laryngeal wall at the level of cricoid cartilage was intact). Difficult patients are those who need for double-level or redo repair and procedures with tracheostomy. RESULTS In the second group overall morbidity after tracheal resections followed by anastomosis was 5.6%. These complications were more common after tracheolaryngeal anastomosis (17%). There were no lethal outcomes after 94 tracheolaryngeal resections. Good long-term results were observed in 89.8% of patients after circular resection. Their quality of life was similar to that of healthy people. Preserved cicatricle tracheal segments during tracheal repair with T-shaped airway tube adversely affects quality of life in these patients in long-term period.
Collapse
Affiliation(s)
- V D Parshin
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - M A Rusakov
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - V V Parshin
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - V A Titov
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - A V Parshin
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - A V Starostin
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| |
Collapse
|
9
|
Timman ST, Schoemaker C, Li WWL, Marres HAM, Honings J, Morshuis WJ, van der Heijden EHFM, Verhagen AFTM. Functional outcome after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis. Ann Cardiothorac Surg 2018; 7:227-236. [PMID: 29707500 DOI: 10.21037/acs.2018.03.07] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background In this study we focus on functional outcomes after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis, with a specific interest in the impact of laryngeal involvement on postoperative outcome. Methods All patients who underwent (laryngo)tracheal surgery for benign pathology between 1996 and 2017 in our centre were included in this retrospective study. Surgical outcomes were procedural success rate, and airway- and voice-related complications. Functional results were assessed using (standardized) questionnaires for quality of life, sensation of dyspnea, swallowing function, and voice perception. Results Of 119 consecutive patients, 47 underwent laryngotracheal resection and reconstruction and 72 underwent segmental tracheal surgery (78% with an end-to-end tracheal anastomosis and 22% with a cricotracheal anastomosis). Overall success rate was 92% and was similar for all groups, with an overall significant improvement in quality of life when compared to the preoperative situation. However, after laryngotracheal surgery, airway-related complications were more common when compared to segmental resections with an end-to-end tracheal anastomosis (30% versus 7%, P=0.003). Additionally, early voice alterations without recurrent nerve palsy were reported twice as often (34% versus 16%, P=0.034) and voice quality experienced during follow-up was significantly worse when compared to segmental resections. Overall response rate to the questionnaires on functional outcome was 63%. Conclusions (Laryngo)tracheal surgery is safe and beneficial, with significant functional improvement during mid- and long-term follow-up. However, laryngeal involvement is a predictor for increased surgical airway-related complications. Additionally, voice alterations without recurrent nerve palsy are far more common after laryngotracheal resection and are a serious handicap. This aspect is underexposed in current literature and deserves further attention during preoperative counseling and patient follow-up. However, the results on functional outcome of this current study should be interpreted with caution due to the somewhat low response rate of the questionnaires.
Collapse
Affiliation(s)
- Simone T Timman
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Christiana Schoemaker
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wilson W L Li
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Henri A M Marres
- Department of Oto-Rhino-Laryngology and Head & Neck Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jimmie Honings
- Department of Oto-Rhino-Laryngology and Head & Neck Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wim J Morshuis
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Ad F T M Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
10
|
Tapias LF, Mathisen DJ. Prevention and management of complications following tracheal resections-lessons learned at the Massachusetts General Hospital. Ann Cardiothorac Surg 2018; 7:237-243. [PMID: 29707501 DOI: 10.21037/acs.2018.01.20] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Tracheal surgery has developed and evolved over the last 50 years, becoming an integral part of the clinical practice of modern thoracic surgeons. Today, surgeons can safely and effectively operate on most patients suffering from post-intubation tracheal stenosis, tracheal tumors and other pathologies that result in an abnormal shape and function of the central airways. The Massachusetts General Hospital (MGH) in Boston witnessed first-hand the birth and growth of tracheal surgery under Dr. Hermes Grillo, becoming a reference center and accumulating one of the largest institutional experiences in the world. This vast experience of the management of patients with tracheal pathologies has allowed our group at MGH to refine the care of these patients, including their judicious preoperative evaluation, meticulous surgical treatment, and dedicated postoperative care. However, this experience has also provided valuable lessons on the potential complications that can arise after tracheal surgery. Here, we attempt to accumulate our institutional knowledge and experience to provide a summary of the key aspects to prevent complications following tracheal resections. Unfortunately, complications can occur despite strict adherence to the core principles of tracheal surgery, and therefore, we also highlight our institutional experience with the early recognition and management of the most common and dreaded complications.
Collapse
Affiliation(s)
- Luis F Tapias
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Douglas J Mathisen
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| |
Collapse
|
11
|
Parshin VD, Isaykin AI, Parshin VV, Gorshkov KM, Nogtev PV, Starostin AV, Parshin AV. [Spinal complications after tracheal resection with anastomosis for cicatricial stenosis]. Khirurgiia (Mosk) 2017:82-87. [PMID: 29076488 DOI: 10.17116/hirurgia20171082-87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- V D Parshin
- Sechenov First Moscow State Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - A I Isaykin
- Sechenov First Moscow State Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - V V Parshin
- Sechenov First Moscow State Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - K M Gorshkov
- Sechenov First Moscow State Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - P V Nogtev
- Sechenov First Moscow State Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - A V Starostin
- Sechenov First Moscow State Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - A V Parshin
- Sechenov First Moscow State Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| |
Collapse
|
12
|
Modified single-stage segmental cricotracheal resection. Eur Arch Otorhinolaryngol 2017; 275:139-146. [DOI: 10.1007/s00405-017-4753-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 09/20/2017] [Indexed: 12/19/2022]
|
13
|
Rotolo N, Cattoni M, Imperatori A. Complications from tracheal resection for thyroid carcinoma. Gland Surg 2017; 6:574-578. [PMID: 29142850 DOI: 10.21037/gs.2017.08.05] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Thyroidectomy associated to en bloc tracheal resection with end-to-end anastomosis is the treatment of choice of thyroid tumor invading the tracheal wall and is associated with a good prognosis. However, the postoperative morbidity is not irrelevant. The present review aims to discuss the complications occurring after this aggressive surgical procedure. The search was performed using PubMed through an overarching for the following terms: "complication of tracheal resection [AND] invasive thyroid cancer". Postoperative complications rate after tracheal sleeve resection with end-to-end anastomosis for thyroid cancer invading tracheal wall range from 15% to 39%. Postoperative mortality is about 1.2%. The most common postoperative complications are: anastomotic dehiscence, airway stenosis, infections and bleeding. Tumor local recurrence can be considered a late on set complication. To conclude, in locally invasive thyroid cancer, en bloc resection of the thyroid with the tracheal segment interested by the tumor provides a good prognosis despite the non-negligible postoperative morbidity rate. Patients' selection and accurate surgical technique performing a tracheal tension-free anastomosis are mandatory to reduce postoperative morbidity and mortality.
Collapse
Affiliation(s)
- Nicola Rotolo
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Maria Cattoni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| |
Collapse
|
14
|
Johnson RF, Rutter M, Cotton R, Vijayasekeran S, White D. Cricotracheal Resection in Children 2 Years of Age and Younger. Ann Otol Rhinol Laryngol 2017; 117:110-2. [DOI: 10.1177/000348940811700207] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives We examine the surgical outcomes of cricotracheal resection in children 2 years of age and younger. Methods We performed a retrospective case study involving a single tertiary care children's hospital. All patients who underwent cricotracheal resection from 1993 through January 2006 were included. Patients 2 years old and younger were compared to patients more than 2 years of age (range, 2 to 44 years). The primary outcomes measured were decannulation and complication rates. We used X2 analyses for categorical variables to detect differences in proportions, Student's t-tests for continuous data, and logistical regression to explore for confounding. Significance was set at α = .05, 2-tailed. Results Fifteen children 2 years of age or younger were identified. Most patients underwent a single-stage operation (n = 12). The overall decannulation rate was 87% (2 failures). Two patients younger than 2 years had postoperative complications, including 1 patient who developed anastomosis dehiscence. When compared to the patients over 2 years of age, patients younger than 2 were more likely to undergo a single-stage procedure (p < .01). Additionally, the cricotracheal resection was more likely to be their first attempt at airway reconstruction (p = .002). Complication and decannulation rates were similar in both groups. Conclusions Cricotracheal resection can be performed safely and effectively in children less than 2 years old.
Collapse
Affiliation(s)
- Romaine F. Johnson
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Medical Center, Cincinnati, Ohio
| | - Michael Rutter
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Medical Center, Cincinnati, Ohio
| | - Robin Cotton
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Medical Center, Cincinnati, Ohio
| | - Shyan Vijayasekeran
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Medical Center, Cincinnati, Ohio
| | - David White
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Medical Center, Cincinnati, Ohio
| |
Collapse
|
15
|
Parshin VD, Titov VA, Parshin VV, Parshin AV, Berikkhanov Z, Amangeldiev DM. [Circular tracheal resection for cicatrical stenosis and functioning tracheostomy]. Khirurgiia (Mosk) 2017:23-32. [PMID: 28914829 DOI: 10.17116/hirurgia2017923-32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM To analyze the results of tracheal resection for cicatricial stenosis depending on the presence of tracheostomy. MATERIAL AND METHODS 1128 patients with tracheal cicatricial stenosis were treated for the period 1963-2015. The first group consisted of 297 patients for the period 1963-2000, the second group - 831 patients for the period 2001-2015. Most of them 684 (60.6%) were young and able-bodied (age from 21 to 50 years). In the first group 139 (46.8%) out of 297 patients had functioning tracheostomy. For the period 2001-2015 tracheostomy was made in 430 (51.7%) out of 831 patients with cicatricial stenosis. Time of cannulation varied from a few weeks to 21 years. RESULTS Re-tracheostomy within various terms after decanulation was performed in 68 (15.8%) patients. Tracheal resection with anastomosis was performed in 59 and 330 in both groups respectively. At present time these operations are performed more often in view of their standard fashion in everyday practice. In the second group tracheal resection followed by anastomosis was observed in 110 (25.6%) out of 430 patients with tracheostomy that is 4.4 times more often than in previous years. In total 2 patients died after 330 circular tracheal resections within 2001-2015 including one patient with and one patient without tracheostomy. Mortality was 0.6%. Moreover, this value was slightly higher in patients operated with a functioning tracheostomy compared with those without it - 0.9 vs. 0.5% respectively. The causes of death were bleeding into tracheobronchial lumen and pulmonary embolism. The source of bleeding after tracheal resection was innominate artery. Overall incidence of postoperative complications was 2 times higher in tracheostomy patients compared with those without it - 22 (20%) vs. 26 (11.8%) cases respectively. Convalescence may be achieved in 89.8% patients after circular tracheal resection. Adverse long-term results are associated with postoperative complications. So their prevention and treatment will improve the outcomes.
Collapse
Affiliation(s)
- V D Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - V A Titov
- Sechenov First Moscow State Medical University, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - V V Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - A V Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - Z Berikkhanov
- Sechenov First Moscow State Medical University, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - D M Amangeldiev
- Sechenov First Moscow State Medical University, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| |
Collapse
|
16
|
Madariaga ML, Gaissert HA. Reresection for recurrent stenosis after primary tracheal repair. J Thorac Dis 2016; 8:S153-9. [PMID: 26981266 DOI: 10.3978/j.issn.2072-1439.2016.01.66] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Failure of the anastomosis after primary tracheal reconstruction for benign disease is uncommon. Here we review the available evidence on tracheal restenosis and the results of second reconstructions. Factors associated with failed primary anastomosis are examined. Temporizing immediate and alternative long-term management with T-tube or tracheostomy is described, emphasizing the role of tracheal stenting in abating the urgency for reoperation. From available evidence, elective reoperative treatment of failed tracheal reconstruction should be considered in selected patients after careful review and reversal of patient- and operation-specific factors that initiated failure. Referral to a high-volume center with a deep bench of nursing, anesthesiologic and surgical expertise is recommended for reoperation.
Collapse
Affiliation(s)
- Maria Lucia Madariaga
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Henning A Gaissert
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| |
Collapse
|
17
|
D'Andrilli A, Maurizi G, Andreetti C, Ciccone AM, Ibrahim M, Poggi C, Venuta F, Rendina EA. Long-term results of laryngotracheal resection for benign stenosis from a series of 109 consecutive patients. Eur J Cardiothorac Surg 2016; 50:105-9. [DOI: 10.1093/ejcts/ezv471] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/04/2015] [Indexed: 11/12/2022] Open
|
18
|
Sihag S, Wright CD. Prevention and Management of Complications Following Tracheal Resection. Thorac Surg Clin 2015; 25:499-508. [DOI: 10.1016/j.thorsurg.2015.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
19
|
Preoperative assessment and classification of benign laryngotracheal stenosis: a consensus paper of the European Laryngological Society. Eur Arch Otorhinolaryngol 2015; 272:2885-96. [DOI: 10.1007/s00405-015-3635-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/19/2015] [Indexed: 12/19/2022]
|
20
|
Piazza C, Del Bon F, Paderno A, Grazioli P, Mangili S, Lombardi D, Nicolai P, Peretti G. Complications After Tracheal and Cricotracheal Resection and Anastomosis for Inflammatory and Neoplastic Stenoses. Ann Otol Rhinol Laryngol 2014; 123:798-804. [DOI: 10.1177/0003489414538764] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This study aimed to evaluate complications and success rates of tracheal resection and anastomosis (TRA) and cricotracheal resection and anastomosis (CTRA) in patients treated in 2 academic institutions. Methods: Retrospective charts review of 137 patients submitted to TRA/CTRA. Fifty (36.5%) had neoplastic (group A) and 87 (63.5%) benign (group B) stenoses. Using univariate analysis, age, medical comorbidities, previous radiotherapy, type of TRA/CTRA, association with neck dissection and thyroidectomy, length of resected airway, and preoperative tracheotomy were evaluated to identify factors predictive of complications and outcomes. Results: The mean length of resected airway was 2.7 and 3 cm in groups A and B, respectively. Overall decannulation and complication rates for group A were 96% and 36%, and 99% and 46% for group B, respectively. Length of airway resected and presence of preoperative tracheotomy had a statistically significant effect on major surgical complications. Age older than 70 and cardiovascular and pulmonary comorbidities were significantly associated with the incidence of major medical complications. No statistically significant difference was found considering the complication rates of group A versus group B. Conclusion: Even though the overall success rate of TRA/CTRA is high, it should always be regarded as a major surgical procedure with a non-negligible incidence of complications.
Collapse
Affiliation(s)
- Cesare Piazza
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Francesca Del Bon
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Paola Grazioli
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Stefano Mangili
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Davide Lombardi
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Genoa, Genoa, Italy
| |
Collapse
|
21
|
Acquired subglottic stenosis: aetiological profile and treatment results. The Journal of Laryngology & Otology 2014; 128:641-8. [DOI: 10.1017/s0022215114000966] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectives:To analyse the aetiological profile and surgical results of patients with acquired chronic subglottic stenosis, and formulate a surgical scheme based on an audit of various surgical procedures.Methods:Thirty patients were treated by 65 procedures (31 endoscopic and 34 external) between 2004 and 2009.Results:Isolated subglottic stenosis was noted as unusual in the majority (27 cases), demonstrating contiguous tracheal or glottic involvement. The major aetiologies were intubation injury (n = 8) and external injury (n = 21) (i.e. blunt trauma, strangulation or penetrating injury). Vocal fold immobility and cartilage framework involvement were frequent with external injury and infrequent with intubation injury. Luminal restoration was achieved by endoscopic procedures in 2 cases, external procedures in 19 cases, and external plus adjuvant endoscopic procedures in 8 cases. The preferred surgical options were: endoscopic procedures, restricted to short, recent, grade I or II mucosal stenosis cases; and external procedures for all other stenosis situations, including isolated subglottic (anterior cricoid split plus cartilage graft), subglottic and glottic or high subglottic (anterior plus posterior cricoid split with cartilage graft), and subglottic and tracheal (cricotracheal resection with anastomosis).Conclusions:External injury stenosis has a worse profile than intubation injury stenosis. Anatomical categorisation of subglottic stenosis guides surgical procedure selection. Endoscopic procedures have limited indications as primary procedures but are useful adjunctive procedures.
Collapse
|
22
|
Rubikas R, Matukaitytė I, Jelisiejevas JJ, Račkauskas M. Surgical treatment of non-malignant laryngotracheal stenosis. Eur Arch Otorhinolaryngol 2014; 271:2481-7. [PMID: 24652116 DOI: 10.1007/s00405-014-2981-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 02/21/2014] [Indexed: 11/25/2022]
Abstract
The objectives of this study were the following: (1) to analyze the results of surgical treatment of non-malignant subglottic laryngeal and tracheal stenosis, (2) to evaluate the feasibility and technical aspects of the video mediastinoscopy for the mobilization of the mediastinal trachea, (3) to evaluate the influence of the early internal condition of the anastomosis on the development of restenosis. From 1996 up to 2013, 75 patients aged 11-78 years underwent surgery for post-intubation/tracheostomy (71 patients), post-traumatic (3 patients), and idiopathic (1 patient) subglottic laryngeal and tracheal stenosis. Twenty-three (30.7 %) patients with subglottic laryngeal and upper tracheal stenosis underwent cricotracheal resection and thyrotracheal anastomosis (group A), while 52 (69.3 %) patients with tracheal stenosis underwent tracheal resection and cricotracheal or tracheotracheal anastomosis (group B). The length of the resected segment in patients of groups A and B was 28-55 (42 ± 11) mm and 18-65 (36 ± 14) mm, respectively, (p = 0.22). Perioperative complications within 30 days occurred in eight (34.8 %) patients of group A, and in six (11.5 %) patients of group B (p = 0.04). There was one intraoperative and one postoperative death on the third day due to heart failure. The excellent results were achieved in 63 (86.3 %), satisfactory in 8 (11.0 %), and unsatisfactory in 2 (2.7 %) patients. The incidence rate of perioperative complications is related to the location of the stenosis and the type of the resection and anastomosis. Video mediastinoscopy simplifies the mobilization of the mediastinal trachea, which allows for carrying out the anastomosis with minimal tension. Early internal abnormalities of the anastomosis predict its restenosis.
Collapse
Affiliation(s)
- Romaldas Rubikas
- Clinic of Cardiac, Thoracic and Vascular Surgery, Lithuanian Health Sciences University , Eivenių 2, 5009, Kaunas, Lithuania,
| | | | | | | |
Collapse
|
23
|
Gómez-Caro A, Morcillo A, Wins R, Molins L, Galan G, Tarrazona V. Surgical management of benign tracheal stenosis. Multimed Man Cardiothorac Surg 2014; 2011:mmcts.2010.004945. [PMID: 24413853 DOI: 10.1510/mmcts.2010.004945] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This chapter provides a step-by-step explanation of the indications, basic technique and pitfalls of tracheal surgery for cases of benign tracheal stenosis. Approach, trachea dissection and end-to-end anastomosis in tracheal surgery is described in detail. An algorithm for laryngotracheal technique selection according to different criteria (stenosis location, vocal cords status and tracheal mucosa and/or cartilaginous larynx involvement) is also depicted. Finally, a review of the most important reported series in tracheal surgery is presented.
Collapse
Affiliation(s)
- Abel Gómez-Caro
- Department of General Thoracic Surgery, Hospital Clinic, University of Barcelona (UB), Barcelona, Spain
| | | | | | | | | | | |
Collapse
|
24
|
Schilt PN, Musunuru S, Kokoska M, McRae B, O'Neill D, Halum SL. The effect of cartilaginous reinforcing sutures on initial tracheal anastomotic strength: a cadaver study. Otolaryngol Head Neck Surg 2012; 147:722-5. [PMID: 22527049 DOI: 10.1177/0194599812445859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE During tracheal resection with primary anastomosis, cartilaginous reinforcing sutures may be placed outside of the primary anastomosis with the goal of preventing early dehiscence. The direct effect of such reinforcing sutures on anastomotic strength has not been previously investigated. The goal of this study was to determine if the addition of cartilaginous reinforcing sutures adds to tracheal anastomosis stability. STUDY DESIGN Prospective cadaver study. SETTING This research was conducted at an anatomy lab at Indiana University School of Medicine. SUBJECTS AND METHODS Twelve cadaver tracheas were harvested. Each trachea was bifurcated, with 1 segment of each trachea transected and anastomosed using circumferential sutures and the remaining tracheal segment undergoing the same procedure with the addition of cartilaginous reinforcing sutures. Segments (proximal versus distal) were alternated to control for potential anatomic-based strength differences. The force necessary for anastomotic rupture was measured, and a Wilcoxon signed-rank test was used to compare means. RESULTS Analysis demonstrated the mean anastomotic rupture point for tracheas with reinforcing sutures was 297 N (95% confidence interval = 241.1-352.9), while the mean for trials without reinforcing sutures was 173 N (95% confidence interval = 142.63-203.37; P = .0054). The point of rupture occurred at the anastomosis in 1 case with reinforcing sutures and in 8 of 11 cases without reinforcing sutures. CONCLUSIONS Cartilaginous reinforcing sutures were found to provide a higher force requirement for tracheal anastomotic rupture when compared with anastomoses without these sutures. This improved stability in tracheal anastomosis may result in a decreased risk of early tracheal rupture after anastomosis.
Collapse
Affiliation(s)
- Peter N Schilt
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
| | | | | | | | | | | |
Collapse
|
25
|
Yamamoto K, Kojima F, Tomiyama KI, Nakamura T, Hayashino Y. Meta-Analysis of Therapeutic Procedures for Acquired Subglottic Stenosis in Adults. Ann Thorac Surg 2011; 91:1747-53. [DOI: 10.1016/j.athoracsur.2011.02.071] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 02/17/2011] [Accepted: 02/22/2011] [Indexed: 10/18/2022]
|
26
|
Schilt PN, McRae BR, Akkus O, Cordes SR, Halum SL. An experimental model to investigate initial tracheal anastomosis strength. Laryngoscope 2010; 120:1125-8. [PMID: 20513028 DOI: 10.1002/lary.20908] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Early anastomotic dehiscence is a devastating complication of segmental tracheal resection. Although wound healing, patient comorbidities, and anastomotic tension are all influential factors, there is a paucity of information available on initial tracheal stability after various tracheal anastomosis techniques in human tissue. STUDY DESIGN Prospective cadaver study. METHODS We present a novel, inexpensive pulley-based system to apply symmetric tension on the trachea in a longitudinal direction to the point of anastomotic dehiscence. The validity of this mechanism was confirmed with trials using incrementally increasing quantities of the same suture type. Twenty-four trials were then performed on 12 cadaver tracheas (six fresh and six preserved) to compare anastomotic strength with two commonly used suture materials (3-0 polyglactin [Vicryl] vs. 3-0 polydioxanone [PDS]). RESULTS Validation studies demonstrated that the force increased appropriately with an increasing number of sutures tested. In the tracheal anastomoses, tracheal suture pull-through was the most common mechanism of dehiscence, regardless of suture type. No significant difference in anastomotic stability was detected between the fresh versus preserved cadaver tracheas. The mean anastomotic strength was slightly greater for Vicryl (179.9 N) when compared to PDS (161.5 N), but the difference did not reach significance (P = .207). CONCLUSIONS We introduce an inexpensive tool for measuring initial tracheal anastomosis stability with human cadavers, which demonstrated no difference in the tracheal pull-through strength of Vicryl and PDS.
Collapse
Affiliation(s)
- Peter N Schilt
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | | | | |
Collapse
|
27
|
Wierzbicka M, Szyfter W, Gawecki W, Popko M, Leszczyńska M. [The systems of classification of laryngo-tracheal stenosis]. Otolaryngol Pol 2009; 63:331-7. [PMID: 19999750 DOI: 10.1016/s0030-6657(09)70136-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Laryngo-tracheal stenosis (LTS) is a relatively rare disease, which develops in very heterogenous group of patients. Careful diagnostics and classification are essential for planning the following treatment and assessing its results. To classify and treat LTS, endoscopic and imaging techniques are required. In this publication basing on the literature review different systems of LTS classifications are described in details. Additionally basing on our clinical experience the probe of choosing the best classification for Polish ENT and thoracosurgery departments was undertaken. In our opinion the use of complex grading systems is unreal in everyday work by Polish ENT surgeons and thoracosurgeons. We suggest to implement the Cotton's system and Medical Research Council dyspnea scale as the optimal way to classify and asses the outcomes of LTS treatment. The former system is well known and widely advocated in Poland, the latter requires a modicum of time from the physician. Both scales, as a combination of subjective and objective parameters show a strong correlation and therefore complement each other.
Collapse
|
28
|
Szyfter W, Nowak K, Kruk-Zagajewska A. [Experiences with treatment of extended laryngo-tracheal stenosis with employment of transversal resection of trachea]. Otolaryngol Pol 2009; 62:695-9. [PMID: 19205514 DOI: 10.1016/s0030-6657(08)70342-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED The aim of this study is to evaluate the results obtained in Department of Otolaryngology et Oncology with transversal resection of trachea acc. to Pearson technique for postintubation stenosis. METHODS from January 2000 to January 2008 ten patients with subglottic postintubation stenosis underwent surgical treatment, using Pearsons method of operation with preservation of recurrent nerves and no postopereative tracheostomy. Mean stenosis length was 2 cm, the length of of airway resection was 1,5-4 cm. RESULTS There was no surgical or postoperative complications, all the patients get totally health, no restenosis was observed. The results confirm that the Pearsons method of operation is an adequate treatment for subglottic stenosis.
Collapse
Affiliation(s)
- Witold Szyfter
- Klinika Otolaryngologii i Onkologii Laryngologicznej, Uniwersytetu Medycznego im. Karola Marcinkowskiego w Poznaniu
| | | | | |
Collapse
|
29
|
Babarro Fernández R, Martínez Morán A, Martínez Vidal J, Vázquez Barro JC, Sarandeses García A. Resection With End-to-End Anastomosis for Post-Intubation Tracheal Stenosis. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s2173-5735(07)70293-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
30
|
Resección con anastomosis término-terminal en la estenosis traqueal tras intubación. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s0001-6519(07)74870-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
31
|
Diemel KD, Branscheid D. [Intensive care treatment following thoracic surgery]. Chirurg 2006; 77:674-81. [PMID: 16868772 DOI: 10.1007/s00104-006-1213-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Intensive care in thoracic surgery requires highly specialised abilities and knowledge in addition to usual intensive care standards. The operative chest intensivist must be experienced in special surgical methods, interventional bronchology, and tube management. Cooperating with chest physicians and anaesthesiologists, he takes the central position in intensive therapy. This is described in detail and explained by examples. Furthermore, aspects of education in this specialty will be emphasised.
Collapse
Affiliation(s)
- K D Diemel
- Thoraxchirurgische Abteilung, Krankenhaus Grosshansdorf, Zentrum für Pneumologie und Thoraxchirurgie, Wöhrendamm 80, 22927 Grosshansdorf.
| | | |
Collapse
|