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Ann Thorac Surg 2007;84:211-214
© 2007 The Society of Thoracic Surgeons
Department of General Thoracic Surgery, Masih Daneshvari Hospital, Shaheed Beheshti University of Medical Science, Tehran, Iran
Accepted for publication March 19, 2007.
* Address correspondence to Dr Farzanegan, Department of General Thoracic Surgery, Masih Daneshvari Hospital, Shaheed Beheshti University of Medical Science, Shaheed Bahonar Ave, Darabad, PO Box 19575/154, Tehran, 1956944413 Iran (Email: roya_farzanegan{at}yahoo.com).
Background: A number of postintubation tracheal stenoses involve different and separate segments. Treatment of these types of strictures is complicated with obscure results, infrequently reported in literature.
Methods: A total of 648 patients underwent treatment for tracheal or subglottic stenosis from September 1993 through October 2005; of those, 26 cases had two separate stenotic segments. Four types of therapeutic approaches were considered for these 26 patients: one-stage resection of the stenotic sites; two-stage resection of the stenotic sites; resection of one stricture and treatment of the second one by nonresectional methods such as dilatation, laser, stenting, T-tube, or tracheostomy; or treatment of both lesions by nonresectional methods. The therapeutic approach for each patient was determined by the surgeon and was based on the nature and location of stenoses, length of stenoses and the distance between the two stenotic sites.
Results: There were 20 male patients (76.9%) and 6 female patients (23.1%), with a mean age of 23.9 years (range, 4 to 64). Fourteen patients had tracheal stenosis and 12 had both tracheal and subglottic involvement. Five patients underwent type 1 therapeutic approach whereas 4, 9, and 8 patients underwent types 2, 3, and 4, respectively. Mean length of resection was 58.9 mm in those who underwent complete resection of the stenotic sites (range, 30 to 90 mm). There were 2 complications, 1 stomal fistula and 1 wound infection. Follow-up was accomplished in all patients with a mean period of 21.5 months (range, 1 to 108). Sixteen patients achieved satisfactory results (good voice and airway), 7 are still under treatment (requiring stent, tracheostomy, or repeated dilatation), and 3 died (2 type 3 and 1 type 4). Two deaths were due to T-tube obstruction, and 1 was due to acute obstruction of the stenotic part.
Conclusions: Resection of both strictures and reconstruction of airway are feasible in some patients with multisegmental tracheal stenosis with good results. When resection of both strictures is not feasible, a combination of resectional and nonresectional managements could be helpful for the vast majority of patients.
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Ann. Thorac. Surg. 2007 84: 215.
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A. Abbasidezfouli Reply Ann. Thorac. Surg., April 1, 2008; 85(4): 1500 - 1501. [Full Text] [PDF]
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E. A. Rendina Invited commentary Ann. Thorac. Surg., July 1, 2007; 84(1): 215 - 215. [Full Text] [PDF]
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