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Multi-Institutional Endoscopic Resection and Reconstitution for Idiopathic Subglottic Stenosis.

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Endoscopic resection (ER) is a minimally invasive surgery for subglottic stenosis (SGS). ER as primary treatment shows durable outcomes and improved lung function, with recurrence rates comparable to open surgery.

Keywords:
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Area of Science:

  • Otolaryngology
  • Minimally Invasive Surgery
  • Respiratory Medicine

Background:

  • Subglottic stenosis (SGS) is a rare airway obstruction.
  • Endoscopic resection (ER), or the Maddern procedure, is a minimally invasive surgical option for SGS introduced 10 years ago.
  • Limited data exists on the long-term durability and patient selection for ER.

Purpose of the Study:

  • To evaluate the durability, patient selection criteria, and complication rates of ER for idiopathic SGS.
  • To compare outcomes of ER as a primary definitive procedure versus a rescue procedure.

Main Methods:

  • A multi-institutional retrospective review of 36 ER procedures in 34 patients with idiopathic SGS (2016-present).
  • Patients were stratified into primary definitive (only prior dilations) and rescue (prior laser, open surgery, or ER) cohorts.
  • Outcomes assessed included recurrence, tracheostomy need, peak expiratory flow rates (PEFR), and surgery-free interval.

Main Results:

  • The study included 33 females and 1 male, with an average age of 49 years.
  • Recurrence rates were 21% for primary definitive ER and 71% for rescue ER.
  • Successful ER significantly improved PEFR (55% to 97% expected) and extended the surgery-free interval (8.4 to 61.6 months), with sustained results at follow-up.

Conclusions:

  • Minimally invasive ER is a durable primary treatment for idiopathic SGS, offering outcomes comparable to open cricotracheal resection.
  • ER as a rescue procedure has a higher recurrence rate.
  • ER significantly improves airway patency and quality of life for SGS patients.