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Tracheal resection and reanastomosis in the neonatal period
S Islam1, P T Masiakos, D P Doody
1Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114-2696, USA.
Insights
This study shows that tracheal resection and reanastomosis (TRR) is a safe and successful treatment for neonates with severe congenital tracheal stenosis requiring extracorporeal life support (ECLS). Both infants survived and had no narrowing at the repair site.
Area of Science:
- Pediatric Surgery
- Neonatal Respiratory Care
- Congenital Airway Anomalies
Background:
- Severe congenital tracheal stenosis is a rare condition often managed conservatively.
- Surgical repair (tracheal resection and reanastomosis - TRR) has been reported in older infants but not in neonates.
- Two neonates with life-threatening respiratory failure due to tracheal stenosis required extracorporeal life support (ECLS).
Observation:
- Both neonates presented with severe respiratory failure and pulmonary hypertension on day one of life.
- Complex congenital anomalies were present in one patient, including lung agenesis and tracheoesophageal fistula.
- Surgical repair (TRR) was performed on day 3 and day 7 of life while the patients were on ECLS.
Findings:
- Both neonates survived the TRR procedure without bleeding complications.
- Patients were successfully weaned from ECLS post-surgery.
- Both infants are alive and well at long-term follow-up with no evidence of tracheal narrowing at the repair site.
Implications:
- Tracheal resection and reanastomosis (TRR) is a viable and safe surgical option for neonates with focal tracheal stenosis and severe respiratory failure.
- This approach can be successfully implemented in critically ill neonates supported by extracorporeal life support (ECLS).
- Early surgical intervention may offer a favorable long-term outcome for this rare condition.
Background/Purpose:
Severe congenital tracheal stenosis is rare. Most of these can be managed conservatively before elective repair. Focal tracheal stenosis has been treated with resection of the involved trachea and primary reanastomosis in older infants. The authors found no reports of repair of this lesion in neonates. Two patients are presented with severe respiratory failure on the first day of life that required extracorporeal life support (ECLS) who underwent successful tracheal resection and reanastomosis (TRR) during the first week of life.
Methods:
A retrospective review was conducted.
Results:
Both babies had severe pulmonary hypertension and carbon dioxide retention despite maximal therapy and were placed on ECLS shortly after transfer. One had an isolated stenosis of the upper trachea, and the other had agenesis of the right lung, esophageal atresia with tracheoesophageal fistula, and a tracheal stenosis at the end of a short trachea with a long, narrow left bronchus. Both underwent diagnostic studies and had surgical repair while on ECLS at day 3 and 7 of life without bleeding complications. They were weaned off ECLS 1 and 8 days after surgery. One patient was extubated and did well. The other was extubated transiently, but required a tracheostomy because of left mainstem bronchomalacia. Both are alive and well at 18 and 38 months of age, with no narrowing of the repairs.
Conclusion:
In the setting of severe respiratory failure requiring ECLS support, TRR can be performed safely and successfully in the neonate with focal tracheal stenosis.