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Pediatric tracheal surgery
Cameron D Wright1, Brian B Graham, Hermes C Grillo
1Division of General Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA. wright.cameron@mgh.harvard.edu
Insights
Pediatric tracheal operations, though uncommon, can achieve stable airways. However, resections exceeding 30% of the trachea increase anastomotic failure risk in children.
Area of Science:
- Pediatric surgery
- Thoracic surgery
- Respiratory medicine
Background:
- Pediatric tracheal procedures are infrequent.
- This study reviews institutional experience to define management and outcomes.
- Understanding these rare procedures is crucial for pediatric respiratory care.
Purpose of the Study:
- To clarify the management and results of pediatric tracheal operations.
- To identify factors influencing complications and outcomes in children undergoing tracheal surgery.
- To establish best practices for pediatric airway reconstruction.
Main Methods:
- Retrospective review of pediatric tracheal operations from 1978 to 2001.
- Analysis of 116 children with various tracheal pathologies including stenosis, neoplasm, tracheomalacia, and trauma.
- Categorization of procedures into minor and major operations, including tracheal resection and laryngotracheal resection.
Main Results:
- Postintubation stenosis was the most common diagnosis (62%).
- Major operations included tracheal resection (58%) and laryngotracheal resection (28%).
- Complications occurred in 35% of patients, with higher rates in younger children and those with prior operations. Resections >30% correlated with anastomotic failure (p=0.0005).
- 80% of patients achieved a stable airway post-procedure. All patients with neoplasms survived.
Conclusions:
- Adult tracheal surgery principles are applicable to children.
- Children tolerate less anastomotic tension than adults.
- Tracheal resections exceeding 30% carry a significant risk of anastomotic failure in pediatric patients.
Background:
Pediatric tracheal procedures are uncommon. We reviewed our experience to clarify management and results.
Methods:
Retrospective single-institution review of pediatric tracheal operations, 1978 to 2001.
Results:
One hundred sixteen children were evaluated, mean age 10.4 years (10 days to 18 years). Tracheal pathology was postintubation stenosis (n = 72; 62%), congenital stenosis (n = 23; 20%), neoplasm (n = 8; 7%), tracheomalacia (n = 7; 6%), and trauma (n = 6; 5%). Twenty-nine patients had previous tracheal operations. Thirty-six patients received only a minor procedure. Eighty patients had major operations: tracheal resection (n = 46; 58%), laryngotracheal resection (n = 22; 28%), slide tracheoplasty (n = 7; 9%), and carinal resection (n = 5; 6%). The mean length of airway resected was 3.3 cm (1.5 to 6 cm), which represented 30% of the entire trachea. Twenty-eight patients (35%) had complications. These included tracheomalacia (n = 3), recurrent nerve injury (n = 3), laryngeal edema requiring intubation (n = 2), stroke (n = 1), esophageal leak (n = 1), and lobar collapse (n = 1). Nineteen patients had anastomotic failure: severe restenosis (n = 6), mild restenosis (n = 9), dehiscence (n = 2), dehiscence with tracheoesophageal fistula (n = 1), and tracheoinnominate fistula (n = 1). Two children died (2.5%). Complications were more frequent in children less than 7 years of age (p = 0.05) and after previous operations (p = 0.02). Longer fractions of tracheal resection (> 30%) were more likely to result in anastomotic failure (p = 0.0005). Sixty-four (80%) patients achieved a stable airway free of any airway appliance. All patients with neoplasms are alive.
Conclusions:
The principles of adult tracheal operations are directly applicable to children and usually lead to a stable, satisfactory airway. Children tolerate anastomotic tension less well than adults; resections more than 30% have a substantial failure rate.