Pediatric tracheal surgery: indications, complications and results

Pediatric tracheal surgery includes several complex and rare procedures. We report the surgical experience at our center.

Our center has multidisciplinary team manages laryngotracheal malformations. We retrospectively analyzed all tracheal surgeries from January 2009 to September 2023, excluding endoscopic cases and tracheostomy insertion, revision, or closure not related to reconstructive tracheal surgery. We evaluated diagnosis, comorbidities, type of surgery, need for tracheostomy, complications, death, outcome in terms of decannulation and adequate caliber airway.

A total of 122 patients with a median age of 2.61 years (0-25.4 years) were operated for congenital (59.8%) or acquired (40.2%) tracheal pathology. The procedures performed were: cricothyroid resection (N.=18; 14.8%), laryngotracheal reconstruction with rib cartilage graft (N.=33; 27%), tracheal resection-anastomosis (N.=20; 16.4%), laryngotracheal cleft closure (N.=5; 4.1%), "slide tracheoplasty" (N.=15; 12.3%), posterior tracheopexy (N.=14; 11.5%); isolated tracheoesophageal fistula closure (N.=17; 13.9%). Depending on the type of operation, cardiac surgeons and otolaryngologists were involved. Preoperative tracheotomy was required in 54 patients and postoperative in 51 patients. We reported a mortality of 6.1%, or seven patients, four of whom died in the immediate postoperative period, but only one death was due to surgical causes. Other intraoperative complications were reported in two patients (1.6%) and postoperative complications in 34 patients (27.9%). Ninety-two patients (75.4%) were alive with adequate airway caliber and no need for tracheostomy.

There are many indications for tracheal surgery and a multidisciplinary approach has been essential. Tracheal surgery is complex and potentially associated with major complications, but outcomes are generally satisfactory.