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Corresponding Author

Mohamed Yasser Elnaggar

Subject Area

Otolaryngology

Article Type

Original Study

Abstract

Objectives: To assess the surgical outcomes among laryngotracheal stenosis patients who underwent tracheal/crico-tracheal resection anastomosis for with application of BloodSTOP iX on the anastomotic line as well as the operative field.

Methods: Fourteen patients participated in this prospective study. The stenotic airway segment was resected circumferentially using primary end-to-end anastomosis. The authors of this article used the same standardized surgical techniques described in the literature and used by them previously. All patients had suprahyoid release, and trachea-hyoid de-tensioning stitches were inserted to reduce the anastomotic tension. To promote healing, BloodSTOP iX was administered across the anastomosis line and surgical outcomes have been evaluated. This study was carried out without a formal control group because of the nature and rarity of the medical condition alongside with the short period of the study.

Results: Following resection, the remaining proximal and distal stumps were used to execute anastomosis as crico-tracheal anastomosis (n = 3), thyro-tracheal anastomosis (n = 5), and tracheo-tracheal anastomosis (n = 6). Before our surgery, two out of fourteen patients had unilateral vocal cord paralysis, one on the right side and the other on the left. The number of resected tracheal rings varied from three to four rings. There were no documented intraoperative problems. Major postoperative problems observed in 6 patients (42.9%) in form of granulation tissue formation at the anastomosis site (n = 5), surgical emphysema/minor air leak through drains (n = 1), hematoma (n = 1), and restenosis (n = 1). Vocal fold edema (n = 2) and transient choking (n = 2) were other minor surgical consequences.

Conclusion: Tracheal/crico-tracheal resection anastomosis represents a major operation with risk of post-operative complications. However, with employing meticulous surgical steps and implementing recent techniques to reduce anastomotic tension and enhance healing such as suprahyoid release, trachea-hyoid, de-tensioning stitches, and the application of BloodSTOP iX, an acceptable complication profile comparable to previous TRA/PCTR series and high decannulation rates were achieved. Absence of control group in this study is its main limitation since it makes direct comparative analysis unpractical.

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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