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Eur J Cardiothorac Surg 2004;25:1059-1064
© 2004 Elsevier Science NL
a Clinic of Thoracic Surgery, National Tuberculosis and Respiratory Diseases Institute, Krajinska Street No. 91, 825 56 Bratislava, Podunajske Biskupice, Slovak Republic
b Department of Pathology, Comenius University of Bratislava, Bratislava, Slovak Republic
c Department of Bronchoscopy, National Tuberculosis and Respiratory Diseases Institute, Bratislava, Slovak Republic
Received 13 October 2003; received in revised form 16 January 2004; accepted 16 February 2004.
* Corresponding author. Tel.: +421-907-127-697; fax: +421-2-452-436-22
e-mail: arpad_pp{at}hotmail.com
Objective: To review a single institution experience with tracheal stenosis treatment and to define a role of endotracheal stenting in tracheal reconstruction surgery. Patients and methods: In the period between January 1991 and January 2003, 163 patients underwent tracheal reconstruction. There were 114 males and 49 females in age range from 0.5 to 79 years (mean 43.2 years). Indications for reconstruction were: posttracheostomic (PostTS) and postintubation (PostINT) stenoses in 111 cases, tumor-stenosis in 24 cases, tracheo-esophageal fistulas (T-Efist) in 17 cases, traumatic laesions in six and functional stenosis in five cases. For these indications, the following procedures were performed: segmental tracheal resection in 87 cases, stenting in 68 cases (by our own modification of Montgomery T-tube in 65 cases and by other traditional endo-stents in three cases). Primary suture of traumatic tracheal wall was performed in five cases. Three cases involved laser intervention and tumor resections, respectively. Results: Segmental tracheal resection (n=87) was successful in almost all the cases (96%). T-tube was applied in 65 cases; the indications included: PostTS and PostINT stenoses in 38 cases, tumors in 17 cases, T-E fistulas in seven cases and functional stenosis in three cases. Twenty-seven patients (41.6%) were successfully treated by this modality. In 19 patients (29.2%), the stenting is still continuing, but they are candidates for extraction of the T-tube in near future. In 19 patients (29.2%) with malignant stenoses, the T-tube was applied only as a palliation. All these patients died due to their underlying malignant disease; the follow-up ranged from 2 to 18 months. Conclusion: Tracheal stenosis is a serious, life-threatening disease with increasing incidence. In our study, the best results were achieved by segmental tracheal resection. However, the endotracheal stenting is the method of choice, when the segmental resection cannot be performed. The management of tracheal stenosis reconstruction by our own modification of Montgomery T-tube is being presented.
Key Words: Endotracheal stenting • Tracheal reconstruction surgery • T-tube • PostTS, Posttracheostomic tracheal stenosis • PostINT, Postintubation tracheal stenosis • T-Efist, Tracheo-esophageal fistula
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A. Pereszlenyi, M. Igaz, I. Majer, and S. Harustiak Reply to Pramesh et al. Eur. J. Cardiothorac. Surg., November 1, 2004; 26(5): 1060 - 1061. [Full Text] [PDF]
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