Multi-Institutional Endoscopic Resection and Reconstitution for Idiopathic Subglottic Stenosis

Endoscopic resection and mucosal reconstitution with epidermal grafting (i.e., ER, known as the Maddern procedure) is a minimally invasive surgery introduced 10 years ago to treat subglottic stenosis (SGS). Here we describe a multi-institutional case series to answer questions about durability, patient selection, and complications.

A retrospective review of idiopathic SGS patients who underwent ER at four institutions since 2016. Patients were stratified by primary definitive (only had previous dilations) and rescue (performed for recurrence after laser wedge resection, open surgery, or previous ER) procedures. Outcomes included complications, disease recurrence, need for tracheostomy, peak expiratory flow rates, and surgery-free period following the operation.

Thirty-six ER procedures were performed in 33 females and 1 male. Average participant age was 49 (30-72) years and BMI 28.5 (19.1-41.5) kg/m². Seven patients underwent tracheostomy with ER surgery, and five were confirmed to be decannulated afterwards. Recurrence was 21% (6/29) and 71% (5/7) in the primary definitive and rescue cohorts, respectively. Successful ER cases had a long-term post-ER surgery free interval of 61.6 months compared to 8.4 months pre-ER (p < 0.05), and peak expiratory flow rates of 97% expected post-ER compared to 55% expected pre-ER (p < 0.0005). These peak expiratory flow rates were maintained at 87% expected at last patient follow-up (p < 0.0005).

This multi-institutional series demonstrates that the minimally invasive ER procedure, when used as primary definitive surgery, provides durable outcomes for iSGS with a recurrence rate similar to that of open cricotracheal resection over the course of an 8-year follow-up period.