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J Thorac Cardiovasc Surg 2002;123:145-152
© 2002 The American Association for Thoracic Surgery
General Thoracic Surgery |
From the Divisions of General Thoracic Surgery and Cardiac Surgery, Massachusetts General Hospital, and the Department of Surgery, Harvard Medical School, Boston, Mass.
Received for publication April 23, 2001. Revisions requested June 19, 2001; revisions received July 24, 2001. Accepted for publication July 27, 2001. Address for reprints: Hermes C. Grillo, MD, Massachusetts General Hospital, Blake 1570, Boston, MA 02114 (E-mail: pguerriero{at}partners.org).
Objective: The difficult problem of congenital tracheal stenosis is infrequent and has been managed with several methods. Patch tracheoplasty has been favored in recent years. Alternative experience with a simpler program of slide tracheoplasty for long-segment stenosis or resection and reconstruction for short-segment stenosis is described and proposed as preferable. Long-term growth after slide tracheoplasty was studied.
Methods: Eleven consecutive patients aged 10 days to 23 years with varied patterns of stenosis (including concurrent pulmonary artery sling, anomalous right upper lobe bronchus, and bridge bronchus) had their stenoses corrected, 8 by means of slide tracheoplasty and 3 by means of resection and anastomosis. Retrospective review was made of hospital course, complications, and long-term results, with observation of growth in 4 patients (from more than 1
-7
years).
Results: All patients are alive and enjoy good airways. Only 3 patients who needed concomitant cardiovascular procedures and 1 with poor ventricular function required bypass. Eight were extubated immediately or on the day of the operation, 1 at 3 days, and 1 at 8 days. A patient with complex anomalies needed 10 days of ventilation. Three had anastomotic granulomas successfully treated by means of a single bronchoscopy. Long-term airway growth was entirely satisfactory after slide tracheoplasty in 4 infants and small children (aged 10 days, 3 months, 6 months, and 3 years, respectively).
Conclusions: Slide tracheoplasty gives excellent short- and long-term results because long congenital stenosis is reconstructed with native tracheal tissue and is therefore immediately stable and lined with normal epithelium, and the operation is accomplished more simply and with a generally more benign postoperative course. Wholly satisfactory growth of the repaired segment occurs. Less common short congenital stenosis is effectively managed with resection and anastomosis.
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