Multi-Institutional Endoscopic Resection and Reconstitution for Idiopathic Subglottic Stenosis

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.