The innovative solution for tracheal reconstruction in the treatment of benign tracheal stenosis
M. Rusakova (Prof), V. Parshina (Prof), M. Simonova*a (Dr)
a Sechenov University Hospital, Moscow, RUSSIAN FEDERATION
* simonova-mary@yandex.ru
Background: T-tube tracheal reconstruction is an effective method for benign tracheal stenosis treatment. We propose our technique of T-tube tracheal reconstruction, which has been successfully performed since 1980-s.
Methods: The idea of proposed technique is a surgical tracheoplasty (dissection of the tracheal scar tissue and tracheoplasty with soft neck tissue with the subsequent T-tube placement to form a tracheal lumen). The main difference from the classic Montgomery T-tube is the use of a wider external limb (diameter 23 mm). Due to a large tracheal stoma, the extraction and placement of the T-tube is carried out through the stoma without the use of bronchoscope. In most cases, patients can remove the tube to clean it themselves and a doctor can easily adjust the T-tube. Usually a T-tube stays in place for 6 months, after this patient is decannulated and a monitoring period (without a tube) is carried out for 2-4 weeks. After that, tracheoscopy is performed to estimate the tracheal lumen. If the diameter of the lumen is sufficient, closure of the persistent stoma via soft neck tissue is performed. If the lumen is insufficient, retracheoplasty is done.
Results: 495 patients who underwent 1210 T-tube tracheal reconstructions from 2001 to 2021 were recruited. 135 (27.27%) patients underwent 2 tracheal reconstructions, 210 (42.43%) patients underwent 3 reconstructions, 150 (30.3%) patients underwent 4 and more reconstructions. 352 (71.11%) patients successfully completed treatment with subsequent closure of stoma. 9 (1.89%) patients remain long-term tracheotomized (tracheostomy tube or T-tube). 85 (17.17%) patients undergo treatment at present. Hospital mortality was 0.81% of the total number of patients.
Conclusion: The innovative T-tube tracheal reconstruction demonstrates high efficiency. This technique is very convenient for both: a patient, who can care for the T-tube and stoma by himself, and a doctor, who can model the tube easily.
Disclosure of funding source(s): none