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Surgical Management of Tracheobronchomalacia in Children: Indications, Results and Techniques Based on a Large Case
F Lena1, F Santoro2, E Ribera2
1Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences, University of Genoa, Genoa, Italy.
Insights
Pediatric tracheobronchomalacia (TBM) surgery using anterior aortopexy (AA) and posterior tracheopexy (PT) shows high effectiveness. Both AA and PT are safe and complementary surgical techniques for TBM management in children.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Respiratory Medicine
Background:
- Pediatric tracheobronchomalacia (TBM) presents with diverse symptoms, necessitating surgical intervention.
- Current consensus on surgical indications and techniques for TBM is limited.
- Clinical outcomes of TBM surgery, including anterior aortopexy (AA) and posterior tracheopexy (PT), require further elucidation.
Purpose of the Study:
- To evaluate surgical indications and outcomes for TBM.
- To analyze surgical techniques employed in a large pediatric cohort.
- To assess the safety and efficacy of AA and PT.
Main Methods:
- Retrospective analysis of 143 pediatric patients undergoing TBM surgery (AA or PT) since 2012.
- Preoperative assessment included dynamic endoscopic evaluation and angio-CT.
- Surgical indications determined by multidisciplinary team evaluation of clinical and endoscopic findings.
- Outcomes assessed via improvement in symptoms like barking cough, stridor, respiratory infections, exercise tolerance, and dysphagia.
Main Results:
- Surgical indications were based on combined clinical and endoscopic findings.
- Anterior aortopexy (AA) was performed in 132 patients, and posterior tracheopexy (PT) in 18 patients.
- Complication and hospital stay rates were comparable: 18.9% and 8 days for AA, 16.7% and 8 days for PT.
- Clinical improvement was observed in 89.1% after AA and 93.8% after PT.
- Complete symptom resolution occurred in 54.6% post-AA and 50% post-PT.
Conclusions:
- Surgical indications for TBM in children are effectively determined by integrating clinical and endoscopic data.
- Multidisciplinary team evaluation is crucial for optimal TBM patient management.
- Anterior aortopexy (AA) and posterior tracheopexy (PT) are safe, effective, and complementary surgical options for pediatric TBM.
Introduction:
Pediatric tracheobronchomalacia (TBM) may require surgical treatment for a range of symptoms, from chronic barking cough to severe respiratory episodes. However, there is limited consensus on surgical indications and techniques. Moreover, few reports describe the clinical outcome of TBM surgery, which includes anterior aortopexy (AA) and posterior tracheopexy (PT). Therefore, we evaluated indications, outcomes and surgical techniques in a large series of patients operated at our center for TBM.
Methods:
Since 2012, surgery was performed in 143 patients: 132 AA, mostly via mini-sternotomy, and 18 PT via thoracoscopy (14 cases robot-assisted). We evaluated surgical indications and outcome, by assessing the following pre- and postoperative parameters: life-threatening episodes, barking cough, stridor, recurrent respiratory infections, reduced exercise tolerance, and dysphagia.
Results:
All patients underwent preoperative dynamic endoscopic evaluation and angio-CT. Surgery (AA, PT or both) was suggested according to a combination of clinical and endoscopic findings, after multidisciplinary team evaluation. Complication and hospital stay rate were similar for AA (18.9 %; 8 days) and PT (16.7 %; 8 days). Clinical improvement was observed in 89.1 % after AA and 93.8 % after PT. Complete resolution of symptoms was observed in 54.6 % after AA and 50 % after PT. Seven patients required both AA and PT.
Conclusion:
In our large series of pediatric patients with TBM, surgical indications were based on a combination of clinical and endoscopic findings. Multidisciplinary team discussion is fundamental for correct management of these patients. AA and PT are complementary techniques, both effective and safe.
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