Advances in Surgery for Congenital Tracheal Stenosis

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Citation
Asia Pacific Cardiology - Volume 1 Issue 1;2007:1(1):68-69

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Congenital tracheal stenosis is a rare disease that benefits from no established surgical procedure due to insufficient experience and a lack of large-scale research.1 If patients develop symptoms early in infancy, surgical repair can be a considerable challenge because the size of the airway is so small that it can be easily obstructed by post-operative oedema.2 If the length of stenotic segment is short, segmental resection and end-to-end anastomosis can be performed, with high success rates.3–6 However, for cases involving the long segment of the trachea, it has been suggested that resection of more than 30% of the tracheal length may lead to excessive anastomotic tension followed by recurrent stenosis or fatal separation.6,7 Long-segment tracheal stenosis is often associated with other anomalies such as pulmonary vascular sling, intracardiac lesion and right-sided aortic arch, which do not occur with with short-segment stenosis.8–10 For these reasons, the management of long-segment tracheal stenosis in infancy still reports significant morbidity and mortality rates.11,12 Various surgical techniques have been suggested for the surgical treatment of this disorder, including rib-cartilage tracheoplasty, peri-cardial patch tracheoplasty, tracheal autograft, and slide tracheoplasty.2,6,11,13–18 Recently, successful results have been reported in several studies.10,11,14,17,19 Nonetheless, there still remains much debate as to the appropriate surgical procedure due to the rarity of the disease and the lack of long-term follow-up data.2,14,17

Patch Tracheoplasty

The limitation on the trachea length that can be resected safely necessitates the introduction of various patch materials for tracheal augmentation. For the patch materials, costal cartilage13 and autologous pericardium have been reported.15 Jaquiss and associates showed favourable results for rib-cartilage tracheoplasty with a low rate of post-operative problems and no operative mortality.14 Backer and associates described an 83% survival rate using peri-cardial patch tracheoplasty.19 Due to its rigidity, cartilage graft cannot offer an airtight suture line. In contrast, peri-cardial patch has an advantage due to its pliability, which allows for an airtight suture line.14

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References
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