Surgical management of children presenting with surgical-needed tracheal stenosis.
OBJECTIVES
The purpose of this work was to assess epidemiological aspects, surgical approach, morbidity and mortality rates of patients presenting with tracheal stenosis requiring surgery, and the evolution of surgical techniques over the last years.


METHODS
We performed a retrospective observational study from 1990 to 2017 in a pediatric tertiary-care center with needing surgery for tracheal stenosis. We analyzed clinical patients' characteristics, type of stenosis, type of surgery and follow-up.


RESULTS
Twenty-eight children presented with tracheal stenosis, half of them with congenital stenosis (complete tracheal rings) and the other half with acquired stenosis (neoplasic or post intubation injury). 39.3% of these stenoses were associated with a vascular ring (61.5% in case of congenital stenosis). Depending on the extent of the stenosis and its origin, the surgery could be performed endoscopically or by an external approach. Enlargement tracheoplasty with an autograft (14.3%) was replaced by slide tracheoplasty with Cardio Pulmonary By-Pass (CPBP, 28.6%) with improved results for the treatment of long segment tracheal stenosis, involving more than 30% of the tracheal length (all were congenital in our study). Slide tracheoplasty has been performed since the late 90's in our institution. 25% of children have had a resection and anastomosis of the trachea because they had a stenosis involving less than 30% of tracheal length. Endoscopic surgery was performed for membranous stenoses, which were often seen after intubation or tracheotomy (32.1% of patients).


CONCLUSION
Effective treatment of surgical tracheal stenosis was performed in 28 children between 1990 and 2015. Surgical techniques have evolved over time, leading to a better management of this rare and serious disease.
['Rossi|Marie-Eva|ME|', 'Moreddu|Eric|E|', 'Macé|Loïc|L|', 'Triglia|Jean-Michel|JM|', 'Nicollas|Richard|R|']
D000293:Adolescent D002648:Child D002675:Child, Preschool D004724:Endoscopy D005260:Female D006801:Humans D007223:Infant D007231:Infant, Newborn D008297:Male D019651:Reconstructive Surgical Procedures D012189:Retrospective Studies D014132:Trachea D014135:Tracheal Stenosis D014182:Transplantation, Autologous D016896:Treatment Outcome
Tracheal stenosis Enlargement tracheoplasty Slide tracheoplasty Comorbidities Multidisciplinary management Resection and reconstruction of the trachea