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Combined trans-stomal endotracheal approach to peri-stomal tracheal pathologies in children
Raviv Allon1, Asaf Oren1, Oshri Wasserzug2
1Pediatric Otolaryngology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Combined laryngoscopy and trans-stomal surgery successfully decannulated nearly 50% of pediatric patients with peristomal pathologies. This minimally invasive approach avoids open surgery but may require multiple procedures for complex cases.
Area of Science:
- Pediatric surgery
- Otolaryngology
- Respiratory medicine
Background:
- Peristomal pathologies are common in tracheostomized children.
- These conditions can hinder decannulation even after the primary issue is resolved.
Purpose of the Study:
- To evaluate the safety and effectiveness of combined direct laryngoscopy and trans-stomal surgery for pediatric peristomal pathologies.
- To assess the decannulation rates and complication profiles associated with this surgical approach.
Main Methods:
- Retrospective review of 105 pediatric patients treated between 2006 and 2018.
- Surgical approach involved combined direct laryngoscopy and trans-stomal endotracheal surgery.
- Outcomes included successful decannulation, intra/postoperative complications, and number of procedures.
Main Results:
- Overall decannulation rate was 49.5%.
- Decannulation rates varied by pathology: 30.3% for tracheal stenosis (TS), 56% for suprastomal granulation tissue (SSGT), and 59.6% for both.
- Trans-stomal microdebrider resection showed higher decannulation rates (66.7% for TS, 88.8% for SSGT).
- Complications occurred in 12.1% (TS), 4% (SSGT), and 20.45% (both).
- Older age and TS were linked to decannulation failure.
Conclusions:
- Combined direct laryngoscopy and trans-stomal surgery facilitates decannulation in nearly half of pediatric patients with peristomal pathologies.
- This technique offers an alternative to open surgery.
- Multiple procedures may be necessary, and complications are more frequent with combined pathologies.
Importance:
Peristomal pathologies in tracheostomized children are common and often difficult to treat. They may preclude decannulation even after the initial pathology that required tracheostomy had been resolved.
Objective:
We evaluated the safety and effectiveness of combined direct laryngoscopy and trans-stomal endotracheal surgery in the treatment of pediatric peristomal pathologies.
Methods:
The medical records of all children and adolescents with tracheostomies who were surgically treated for peristomal pathologies by a combined endotracheal and trans-stomal approach between January 2006 and August 2018 were retrospectively reviewed. Pathologies included stenosis, tracheomalacia, granulation tissue, and a combination of pathologies. Patient demographics and clinical details were retrieved. The primary outcome measure was successful decannulation. Secondary outcome measures were intra- and postoperative complications and number of procedures performed.
Results:
In total, 105 subjects aged 6 months to 17 years who underwent combined direct laryngoscopy and trans-stomal surgery were included. Fifty-two (49.5%) of them were successfully decannulated. The specific decannulation rates were 30.3%, 56%, and 59.6% for tracheal stenosis (TS), suprastomal granulation tissue (SSGT), and both, respectively. Trans-stomal microdebrider resection resulted in decannulation rates of 66.7% for TS and 88.8% for SSGT. Intra- and postoperative complications occurred in 4 (12.1%), 1 (4%), and 9 (20.45%) patients with TS, SSGT, and both, respectively. Older age at the time of first operation (p = .03) and tracheal stenosis (p = .02) were significantly associated with decannulation failure.
Conclusion:
Combined direct laryngoscopy and trans-stomal endotracheal surgery can enable decannulation in almost 50% of children with peristomal pathologies, thus obviating open surgery. Multiple procedures may be required, depending upon the type and severity of the pathology. Complications are more common with multiple pathologies.
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