Evaluation of laser tracheobronchoplasty for treatment of tracheobronchomalacia
I. Atallah*a (Dr), P. Castellanosb (Dr)
a Grenoble Alpes University Hospital, Otolaryngology-Head and Neck Surgery Department, Grenoble, FRANCE ; b Mercy Health — St. Rita’s Ear, Nose and Throat, Lima, Oh, UNITED STATES
* ihab.atallah@gmail.com
Background: Despite different support techniques, the management of tracheobronchomalacia is still a challenging problem. The purpose of our study was to evaluate and to confirm the efficacy of a novel treatment by laser introduced for the first time in 2016 to treat this common disease.
Methods: A consecutive series of patients with a diagnosis of diffuse or segmental tracheobronchomalacia confirmed by transnasal flexible bronchoscopy under local anesthesia that showed excessive dynamic airway collapse during exhalation and or coughing, were treated with two to three holmium laser scarring surgeries of the hyperdynamic tracheal and bronchial walls for the purpose of stiffening them through fibrosis. Patients filled out a Dyspnea Index questionnaire before and after treatment.
Results: Twenty seven patients were treated for their tracheobronchomalacia with a mean age of 51 years. Symptoms included severe dyspnea, dry cough, recurrent pulmonary infections, and respiratory failure. Fifty percent of patients presented with wheezing refractory to traditional treatment. Tracheobronchomalacia was associated with gastroesophageal reflux disease (n=12), obstructive sleep apnea (n=7), and tracheobronchial stenosis (n=6). Only 35 % of patients presented with morbid obesity. All cases showed significant improvement of their respiratory symptoms with a mean postoperative difference of 25 out of a maximum impairment score of 40 (P <0.05) on the Dyspnea Index. The mean number of procedures was 2.1 per patient with the average laser energy delivered per procedure of 1500 joules.
Conclusion: Laser tracheobronchoplasty is a safe, easy to adopt, and effective technique for the treatment of tracheobronchomalacia. It presents a simple alternative to the commonly used procedures like endoluminal stenting and open tracheobronchoplasty.
Reference:
Castellanos P, Mk M, Atallah I. Laser tracheobronchoplasty: a novel technique for the treatment of symptomatic tracheobronchomalacia. Eur Arch Otorhinolaryngol. 2017.
Disclosure of funding source(s): none