Surgical Management of Tracheobronchomalacia in Children: Indications, Results and Techniques Based on a Large Case.

INTRODUCTION

Pediatric tracheobronchomalacia (TBM) may require surgical treatment for a range of symptoms, from chronic barking cough to severe respiratory episodes. However, there is limited consensus on surgical indications and techniques. Moreover, few reports describe the clinical outcome of TBM surgery, which includes anterior aortopexy (AA) and posterior tracheopexy (PT). Therefore, we evaluated indications, outcomes and surgical techniques in a large series of patients operated at our center for TBM.

METHODS

Since 2012, surgery was performed in 143 patients: 132 AA, mostly via mini-sternotomy, and 18 PT via thoracoscopy (14 cases robot-assisted). We evaluated surgical indications and outcome, by assessing the following pre- and postoperative parameters: life-threatening episodes, barking cough, stridor, recurrent respiratory infections, reduced exercise tolerance, and dysphagia.

RESULTS

All patients underwent preoperative dynamic endoscopic evaluation and angio-CT. Surgery (AA, PT or both) was suggested according to a combination of clinical and endoscopic findings, after multidisciplinary team evaluation. Complication and hospital stay rate were similar for AA (18.9 %; 8 days) and PT (16.7 %; 8 days). Clinical improvement was observed in 89.1 % after AA and 93.8 % after PT. Complete resolution of symptoms was observed in 54.6 % after AA and 50 % after PT. Seven patients required both AA and PT.

CONCLUSION

In our large series of pediatric patients with TBM, surgical indications were based on a combination of clinical and endoscopic findings. Multidisciplinary team discussion is fundamental for correct management of these patients. AA and PT are complementary techniques, both effective and safe.