Balloon tracheoplasty in children: results of a 15-year experience

Strictures of the trachea traditionally have been dilated by antegrade bouginage. This method not only dilates but imparts a shearing force to the wall of the trachea. The resultant trauma may contribute to further scarring and aggravation of the stricture. We report a 15-year experience with 37 patients and 158 tracheal dilatations using balloon catheters that impart only radially directed forces and can be precisely placed and gradually inflated. Various adjunctive techniques have been performed, including: (1) electrocautery of granulation tissue; (2) parenteral and local use of steroids; and (3) intraluminal stenting after dilation. Recent experience indicates that this combination of methods is important in improving patient outcome. The principal indications for balloon tracheoplasty include acquired tracheal stenosis from various causes, and congenital subglottic stenosis. Almost all patients received some immediate benefit from balloon tracheoplasty. Fifty-four percent of the patients achieved long-term improvement (with a minimum follow-up of 2 months). Additionally, 10 of 20 children who had been unable to previously tolerate removal of an indwelling tracheostomy tube proceeded to extubation. We have had poor success in treating bronchial and glottic stenosis. Endoscopically directed hydrostatic balloon tracheoplasty is a safe and effective method for the treatment of tracheal stenosis of varying causes. Multiple dilatations are required that gradually improve the character of the tracheal lumen. In selected cases, the procedure may delay or avoid the need for an open tracheoplasty.