Cervical slide tracheoplasty in adults with laryngotracheal stenosis.

OBJECTIVES

1) Evaluate success rates for adults undergoing cervical slide tracheoplasty. 2) Examine complication rates of slide tracheoplasty in adults.

METHODS

A retrospective cohort of adults > 21 years of age undergoing cervical slide tracheoplasty for tracheal stenosis between October 2011 and August 2017 was reviewed. Comorbidities, stenosis grade, etiology of stenosis, primary versus revision surgery, complications, and number of adjunct endoscopic procedures required postoperatively were evaluated.

RESULTS

Nineteen patients (63% female) underwent cervical slide tracheoplasty during the study period (median age 30 years, range 21-70). The most common etiology of stenosis was iatrogenic (68%), followed by congenital etiologies (26%). Fifty-eight percent of patients had undergone a previous open airway procedure. Thirty-nine percent were tracheostomy-dependent prior to surgery, and the remainder had severe exercise intolerance. Sixty-three percent were successfully extubated on the operating room table at the end of the procedure. Six (32%) patients experienced surgical complications, including one anastomotic dehiscence, three neck abscesses requiring incision and drainage (I&D), and replacement of adjunctive airway device in two patients. Seventy percent of the patients required ≥ 1 endoscopic dilation in the first 12 months following surgery, with a median of one (range 1-8) procedure. At most recent follow-up (median 8 months, range 4-64 months), 18 of 19 (95%) of patients had minimal airway symptoms without need for tracheostomy. The one patient who was not decannulated expired of a presumed cardiac event prior to decannulation.

CONCLUSION

Cervical slide tracheoplasty is an excellent reconstructive option for adult patients with tracheal stenosis, including those with history of previous airway reconstruction.

LEVEL OF EVIDENCE: 4 Laryngoscope, 129:818-822, 2019.