Our objective was to analyse the charecteristics and results of tracheal resection and reconstruction.
A total of 287 patients underwent tracheal resection and reconstruction from 1990 to 2004. Postintubation tracheal stenosis was present in 251 patients of which 149 patients had cuff lesions and 97 had stomal lesions. Tracheal resection and reconstruction wee performed for 41 patients who had tracheal tumors. Laryngeal obstructions were seen in 8 patients of which 3 had obstructions in more than one level. The approach was cervical in 232 patients, cervico-mediastinal in 34 patients and through a right thoracotomy in 8 patients. The length of resection of trachea was 1 to 5.5 cm. Preoperatively all the patients were routinely submitted for pulmonary function test, computed tomography of neck and chest with 3 dimension reconstruction and virtual bronchoscopy and flexible fibreoptic bronchoscopy.
The results of surgery were good in 94%, satisfactory in 3% and non-satisfactory in 3% of the patients. Eight patients required Montgomery T tube and tracheostomy in the postoperative period. Nine patients died(3%). Suture line granulations were the most common complications and were seen in 28 patients(9.5%). wound infection was present in 12 patients(4%) and glottic dysfunction in 8 patients(2.7%). Two patients who developed tracheo-innominate artery fistula in the postoperative period underwent emergency exploration and repair. One patient developed quadriplegia following acute neck flexion in the postoperative period.
Tracheal resection and reconstruction remains the best option for patients with tracheal obstruction and yields good results.
Tracheal obstructions due to postintubation tracheal stenosis and tumors in the trachea, the defintive curative treatment is tracheal resection and reconstruction.
Rajan Santosham, None.