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Montgomery T-tube placement in the treatment of benign tracheal lesions

Department of Thoracic Surgery, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy

Received 12 September 2008; received in revised form 23 February 2009; accepted 25 February 2009.

^_* Corresponding author. Tel.: +39 02 26437138; fax: +39 02 26437147. (Email: angelo.carretta{at}hsr.it).

Introduction: Although surgery remains the gold standard for the treatment of benign tracheal stenosis, airway stenting may be indicated in the event of complex lesions or associated diseases. We retrospectively investigated Montgomery T-tube placement as an alternative or complementary treatment to surgery. Methods: From January 1984 to March 2008, 158 patients were treated for benign tracheal lesions. Eighty-three patients underwent airway resection and reconstruction as the only treatment. Seventy-five other patients with complex lesions or major associated diseases were treated with a T-tube and were retrospectively analysed. Seven of them had undergone unsuccessful treatment with Dumon stents. T-tube placement was the only procedure adopted in 51 patients with a contraindication to surgery (group I), a temporary measure in 15 patients prior to surgery (group II), and in 9 patients (group III) for complications of airway reconstruction, 5 of whom were referred from other institutions. Results: Complications after T-tube placement were: stent dislocation in 3 (4%) patients, endoluminal granulomas in 14 (19%), subglottic edema in 3 (4%), and sputum retention in 7 (9%). Treatment of complications (tracheostomy cannula, steroid infiltration, Argon/LASER coagulation, and bronchoscopy) was required in 20 (27%) patients. In group I, the tube was removed in 12 (24%) patients after 35.3 ± 8.2 months following resolution of the stenosis. In group II, the tubes were maintained in place before surgery for 17.1 ± 4.8months. In group III, three stents were removed following tracheal healing after 115.3 ± 3.7months. After 5 years the stents were in place in 82%, 7% and 100% of the patients, respectively in groups I, II and III. Conclusions: Montgomery T-tube placement represents a useful option in patients with complex benign tracheal stenosis or associated diseases as an alternative or complementary treatment to surgery, and is effective even when other types of stents are unsuccessful.

Key Words: Trachea • Stenosis • Benign • Conservative • Stent • T-tube