Outcomes of slide tracheoplasty for congenital tracheal stenosis in 80 children: A 22-year single-center experience

Naoki Shimojima, Akihiro Shimotakahara, Hirofumi Tomita, Toshio Harumatsu, Atsushi Harada, Yutaro Maeda, Yoshifumi Ito, Kazuaki Miyaguni, Ayano Tsukizaki, Kiyotomo Abe, Makoto Hashimoto, Miki Ishikawa, Masaki Honda, Tatsuo Kuroda, Seiichi Hirobe

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Purpose: The application of slide tracheoplasty (STP) in the treatment of congenital tracheal stenosis (CTS) has improved patient outcomes over the past few decades. We reviewed our experiences with the procedure, elucidated risk factors, and discussed important aspects of perioperative management to improve outcomes. Method: Patients with CTS undergoing STP between July 1998 and December 2020 were enrolled. Patient characteristics, perioperative condition, management, operative details, and outcomes, including mortality and postoperative intervention, were collected from medical records. Results: Eighty patients underwent STP. Sixty-five patients (81.3%) had an associated cardiovascular anomaly. Thirteen patients (16.3%) had unilateral lung agenesis or hypoplasia. Preoperative mechanical ventilation was necessary in 54 (67.5%) patients, and extracorporeal membrane oxygenation (ECMO) was required in eight patients (10.0%). An endotracheal tube was placed before the stenotic entrance to avoid granulation. During STP, the trachea was dissected as little as possible to maintain the blood supply. The one-year survival rate was 88.8% (nine patients died). One patient (1.3%) required postoperative balloon dilation, and none required stenting or granulation removal. Of the survivors, 62 (92.5%) achieved successful extubation without tracheostomy. Multivariable analysis revealed complex cardiovascular anomaly (P = 0.05) and preoperative ECMO (P = 0.019) to be adverse predictors of survival. Conclusion: Although STP can be performed successfully in CTS patients, surgeons and families should be aware of factors that may lead to a more difficult postoperative course or increase the mortality. Meticulous, perioperative positioning of the endotracheal tube and preserving the tracheal blood flow can minimize the need for postoperative intervention.

Original languageEnglish
Pages (from-to)1205-1209
Number of pages5
JournalJournal of Pediatric Surgery
Volume57
Issue number7
DOIs
Publication statusPublished - 2022 Jul

Keywords

  • Balloon dilation
  • Complex cardiovascular anomaly
  • Congenital tracheal stenosis
  • Extracorporeal membrane oxygenation (ECMO)
  • Slide tracheoplasty
  • Tracheostomy

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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