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[Sliding traсheal plasty in children under extracorporeal membrane oxygenation (first experience in Russia)]
A Iu Razumovskiĭ1, I I Afukov1, A D Kulaev2
1Chair of Pediatric Surgery, N.I. Pirogov Russian Research Medical University.
Insights
Sliding tracheal plasty under extracorporeal membrane oxygenation improved outcomes for children with extended tracheal stenosis. This surgical technique offers a viable option for complex airway reconstruction in pediatric patients.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Respiratory Medicine
Context:
- Extended tracheal stenosis in children presents significant surgical challenges.
- Complete cartilaginous rings necessitate advanced reconstructive techniques.
- Extracorporeal membrane oxygenation (ECMO) provides critical support during complex airway procedures.
Purpose:
- To evaluate the efficacy of sliding tracheal plasty combined with ECMO for treating extended tracheal stenosis in pediatric patients.
- To assess the safety and outcomes of this surgical approach in young children.
Summary:
- Sliding tracheal plasty with ECMO was performed on 4 children (aged 1.2–4.5 years) with extended tracheal stenosis.
- No intraoperative complications occurred; however, one patient died post-discharge from respiratory failure, and another experienced granulation tissue requiring intervention.
- Postoperative follow-up showed manageable bronchitis in two patients, with one experiencing complete symptom resolution.
Impact:
- This study demonstrates the feasibility of sliding tracheal plasty with ECMO for pediatric extended tracheal stenosis.
- The technique offers a potential solution for complex airway reconstruction, though careful postoperative management is crucial.
- Further research with larger cohorts is warranted to optimize outcomes and minimize complications.
Aim:
To improve the results of surgical treatment of children with extended tracheal stenosis.
Material And Methods:
Since 2013 slidingtraсheal plasty under extracorporeal membrane oxygenation was performed in 4 children aged 1 year 2 months - 4.5 years with extended tracheal stenosis in Children's City Clinical Hospital №13. Patients' weight was from 10,5 to 16 kg. Extended tracheal stenosis and complete cartilag inousrings were confirmed in all patients after peoperative survey. Indications for surgery were based on medical history data, the severity of respiratory failure and survey data. Sliding traсheal plasty by different approach esunder extracorporeal membrane oxygenation was applied in all patients.
Results:
There were no intraoperative complications. In the study group 1 patient died in remote postoperative period after discharge due to deterioration of his condition caused by upper respiratory tract infection and acute respiratory failure. In immediate postoperative period 1 patient had pronounced growth of granulation tissue in the area of anastomosis followed laser photocoagulation and prolonged intubation. The average ICU-stay was 24 days, the duration of mechanical ventilation - 11 days. Follow-up carefor patients was conducted on terms of 4-6 and 12 months after surgery. In 2 patients moderate complaints of recurrent bronchitis without signs of respiratory insufficiency during 6-8 months postoperatively were observed. In one child complaints were completely absent.
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