Faculty Collaboration Database

Side-to-Side Tracheobronchoplasty to Reconstruct Complex Congenital Tracheobronchial Stenosis. Ann Thorac Surg 2017 Aug;104(2):666-673

Date

04/04/2017

Pubmed ID

28366462

DOI

10.1016/j.athoracsur.2017.01.011

Scopus ID

2-s2.0-85016460560 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

BACKGROUND: Long segment tracheobronchial stenosis is a rare congenital anomaly that can also occur in combination with abnormal bronchial arborization. Long segment tracheal reconstruction in the setting of a supernumerary bridging bronchus has been reported; however, these repairs can be particularly complex. We present our experience using the bridging bronchus to augment long segment tracheal stenosis with a side-to-side tracheobronchoplasty.

METHODS: Four patients with complex long segment tracheobronchial stenosis involving a bronchus suis (right upper lobe bronchus) and a bridging bronchus presented with refractory respiratory distress requiring urgent tracheal reconstruction. Patient 1 was initially managed with modified slide tracheoplasty and tracheostomy. Patients 2, 3, and 4 were managed with single-stage procedures. All patients underwent definitive long segment tracheobronchoplasty consisting of a side-to-side anastomosis between the bridging bronchus and the right upper lobe bronchus.

RESULTS: Age at surgery was 569, 69, 24, and 142 days, respectively. Weight at surgery was 9.3, 4.3, 2.7, and 5.9 kg. All patients were weaned from mechanical ventilation at 84, 13, 47, and 8 days after side-to-side tracheobronchoplasty. All patients were alive and free from tracheostomy at follow-up of 6.7, 3.8, 2.7, and 0.5 years.

CONCLUSIONS: Side-to-side tracheal reconstruction is feasible in severe cases of long segment tracheal stenosis with a right upper lobe bronchus and a bridging bronchus. This technique can be successfully applied in high-risk patients and in the neonatal period and can provide excellent midterm results.

Author List

Ragalie WS, Chun RH, Martin T, Ghanayem NS, Berens RJ, Beste DJ, Mitchell ME

Authors

Richard J. Berens MD Professor in the Anesthesiology department at Medical College of Wisconsin
Robert H. Chun MD Professor in the Otolaryngology department at Medical College of Wisconsin
Michael Edward Mitchell MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anastomosis, Surgical
Bronchi
Bronchial Diseases
Bronchoscopy
Constriction, Pathologic
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Male
Thoracic Surgical Procedures
Trachea
Tracheal Stenosis
Treatment Outcome