Laryngotracheal resection can be performed safely without a guardian Chin stitch—a single-centre experience including 165 consecutive patients

2021 ◽  
Author(s):  
Thomas Schweiger ◽  
Matthias Evermann ◽  
Imme Roesner ◽  
Anna-Elisabeth Frick ◽  
Doris-Maria Denk-Linnert ◽  
...  
Keyword(s):  
Postoperative Outcome ◽  
Neurological Complications ◽  
Early Postoperative Period ◽  
Tracheal Resection ◽  
Anastomotic Complications ◽  
Cricotracheal Resection ◽  
Laryngotracheal Reconstruction ◽  
Age At Surgery ◽  
Single Centre Experience ◽  
The Guardian

Abstract OBJECTIVES A tension-free anastomosis is crucial to minimize the risk of airway complications after laryngotracheal surgery. The ‘guardian’ chin stitch is placed to prevent hyperextension of the neck in the early postoperative period. This manoeuvre was introduced early in tracheal surgery and is now routinely performed by many airway surgeons. However, the evidence for or against is sparse. METHODS We performed a retrospective analysis of all adult patients receiving a (laryngo-)tracheal resection at our department from October 2011 to December 2019. According to our institutional standard, none of the patients received a chin stitch. Instead, a head cradle was used to obtain anteflexion of the neck during the first 3 days and patients were instructed to avoid hyperextension of the neck during the hospital stay. The postoperative outcome and the rate of anastomotic complications were analysed. RESULTS A total of 165 consecutive patients were included in this study. Median age at surgery was 53 years (18–80). Seventy-four patients received a tracheal resection, 24 a cricotracheal resection, 52 an extended cricotracheal resection including dorsal mucosectomy and 15 a single-stage laryngotracheal reconstruction. The median resection length was 25 mm (range 10–55 mm). One hundred and sixty-two out of 165 (98.2%) patients had an unremarkable postoperative course. One patient (0.6%) had partial anastomotic rupture after a traumatic reintubation, which required revision surgery and re-anastomosis. Two patients (1.2%) after previous radiation therapy (>60 Gy) developed a partial necrosis of the anastomosis, resulting in prolonged airleak and fistulation. At follow-up, bronchoscopy 3 months after surgery, 92.7% (127/137) of the patients had a proper anastomosis, 6.6% (9/137) had minor granuloma formations at the site of the anastomosis, which were all treated successfully by endoscopic removal. One patient received dilatation for restenosis (0.7%). CONCLUSIONS After sufficient mobilization of the central airways, postoperative anteflexion of the neck supported by a head cradle is sufficient to prevent excessive anastomotic tension and dehiscence. Considering the risk for severe neurological complications associated with the chin stitch, the routine use of this manoeuvre in laryngotracheal surgery should not be recommended.

Pediatric Laryngotracheal Stenosis: Where Are We Heading

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P67-P67
Author(s):  
Kishore Sandu
Keyword(s):  
Recurrent Laryngeal Nerve Palsy ◽  
Anastomotic Dehiscence ◽  
Tracheal Resection ◽  
Vocal Cords ◽  
Cricotracheal Resection ◽  
Laryngotracheal Reconstruction ◽  
Grade Ii ◽  
Partial Cricotracheal Resection ◽  
Grade Iii ◽  
Severe Grade

Objective We compare decannulation rates after Laryngotracheal Reconstruction(LTR) and Cricotracheal Resection(CTR) in matched patients. Glottic Stenosis remains a challenge and can be treated by Extended Partial Cricotracheal Resection(PCTR). The objective of the paper is to systematically classify patients to be treated by these different techniques. Methods In 61% of patients, single-stage PCTR with peroperative resection of the tracheostoma was chosen if no more than 5 tracheal rings were resected with the SGS. If the location of the tracheostoma requires the resection of 6 or more tracheal rings, then PCTR was performed in 2 stages. 13% of children in this group sustained an anastomotic dehiscence, compared to 4.5% of children who had a shorter tracheal resection. 17 patients who weighed under 10 kg of body weight and were less than 1 year old underwent CTR and have all been decannulated. Results It is noteworthy that more than a single procedure was necessary in 68% of the cases to reach the aforementioned results with LTRs, whereas only 18% of the cases needed a second open procedure to achieve decannulation with PCTR. Extended PCTR with LT mold for complex frozen larynges has proven to have promise. Complications included anastomotic granulations, minor dehiscence. No patient had a recurrent laryngeal nerve palsy. Conclusions LTR is a less extensive procedure and is preferred for some grade II and less severe grade III stenoses. CTR is reserved for severe grade III and IV stenosis. Stenosis close to the vocal cords remains a challenge and can be treated by extended PCTR.

scholarly journals Факторы влияющие на динамику качества жизни после хирургического лечения расслоения восходящего отдела и дуги аорты

2018 ◽  
pp. 14-20
Author(s):  
O. V. Kamenskaya ◽  
A. S. Klinkova ◽  
I. Yu. Loginova ◽  
A. M. Chernyavsky ◽  
V. V. Lomivorotov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Aortic Arch ◽  
Postoperative Period ◽  
Neurological Complications ◽  
Early Postoperative Period ◽  
Ascending Aorta ◽  
Cerebral Protection ◽  
Role Functioning ◽  
Cardiopulmonary Failure

Aim. To assess the impact of clinical and intraoperative factors on the dynamics of quality of life (QOL) after aortic prosthetics in patients with chronic dissection of ascending aorta and aortic arch.Material and methods. The study included 56 patients (mean age 50 years) with chronic DeBakey type I aortic dissection. With the help of the SF­36 questionnaire, QOL was examined before and later (12 months) after aortic prosthetics. The method of multivariate linear regression analysis was used to evaluate factors that influence the dynamics of various parameters of QOL in the late postoperative period. Results. Before the operation, patients scored from 52 points and below almost in all parameters of the questionnaire, which indicates a very low initial level of QOL. In the long­term period after aortic prosthetics, a statistically significant improvement in the following physical and psycho­emotional indicators was noted: role functioning (p=0,004); bodily pain (p=0,0001); vitality (p=0,009); social role functioning (p=0,002); emotional role functioning (p=0,009); physical health (p=0,02); mental health (p=0,03). At the same time, there was no positive change in the initial low parameters of general health and psychiatric health perceptions.According to multivariate regression analysis, the dynamics of QOL parameters in the long­term period after surgical treatment of the dissection of ascending aorta and aortic arch are affected by both intraoperative conditions (cerebral protection method) and the early postoperative period (neurological complications, cardiopulmonary failure, atrial fibrillation). Indicators such as gender, age, body weight, comorbidity, type of prosthesis of the ascending aorta, time spent in the intensive care unit, duration of artificial pulmonary ventilation do not have a significant effect on QOL in the long­term postoperative period.Conclusion. Clinical and intraoperative factors that adversely affect the dynamics of various indicators of QOL in long­term periods after prosthetics of the ascending aorta and aortic arch were: cerebral protection in conditions of deep hypothermia and craniocerebral hypothermia against the background of systemic circulatory arrest; development of neurological complications, as well as atrial fibrillation and cardiopulmonary failure in the early postoperative period.

scholarly journals Clinical Characteristics and Long-term Surgical Outcome of Spinal Myxopapillary Ependymoma: A French Cohort of 101 Patients

2021 ◽  
Author(s):  
Anne-Sophie Montero ◽  
Suzanne Tran ◽  
Aymeric Amelot ◽  
Félix Berriat ◽  
Guillaume Lot ◽  
...  
Keyword(s):  
Postoperative Radiotherapy ◽  
Multivariable Analysis ◽  
Postoperative Outcome ◽  
Progression Free Survival ◽  
Subtotal Resection ◽  
Myxopapillary Ependymoma ◽  
Incomplete Resection ◽  
Sphincter Function ◽  
Age At Surgery

Abstract Purpose: Myxopapillary ependymoma (MPE) is the most frequent tumor affecting the medullary conus. The surgical therapeutic management is still debated and only few studies have focused on the postoperative clinical outcome of patients. This study aimed to demonstrate long-term postoperative outcome and to assess the predictive factors of recurrence as well as the clinical evolution of these patients.Methods: From 1984 to 2019, in four French centers 101 adult patients diagnosed with MPE were retrospectively included. Results: Median age at surgery was 39 years. Median tumor size was 50mm and lesions were multifocal in 13% of patients. All patients benefited from surgery and one patient received postoperative radiotherapy. Gross total resection was obtained in 75% of cases. Sixteen percent of patients presented recurrence after a median follow-up of 70 months. Progression free survival at 5 and 10 years were respectively estimated at 83% and 79%. After multivariable analysis, sacral localization, and subtotal resection were shown to be independently associated with tumor recurrence. 85% of the patients had a favorable evolution concerning pain. Twelve percent of the patients presented a postoperative deterioration of sphincter function and 4% of motor function. Conclusion: Surgery alone is an acceptable option for MPE patients. Patients with sacral location or incomplete resection are at high risk of recurrence and should be carefully monitored.

Laryngotracheal Reconstruction in Adults Aged 60 Years and Older

2019 ◽  
Vol 160 (6) ◽  
pp. 1065-1070 ◽  
Author(s):  
Saad C. Rehman ◽  
Deborah X. Xie ◽  
James R. Bekeny ◽  
Alexander Gelbard ◽  
Christopher T. Wootten
Keyword(s):  
Complete Blood Count ◽  
Tertiary Care ◽  
Case Series ◽  
Tracheal Resection ◽  
Distribution Width ◽  
Free Survival ◽  
Laryngotracheal Reconstruction ◽  
Airway Reconstruction

Objective The primary aim of this study is to evaluate the safety, efficacy, and execution of major open laryngotracheal operations for patients in the advanced decades. Study Design Case series with chart review. Setting Multidisciplinary clinic at a tertiary care academic hospital. Subjects and Methods Patient characteristics, operative course, and postoperative outcomes were retrospectively recorded for all airway reconstruction operations performed between 1999 and 2016 on patients aged ≥60 years Long-term success was defined as prosthesis-free survival at last follow-up. Descriptive statistics were performed. Results Twenty-nine patients met inclusion criteria, and the median age was 71 years (interquartile range, 63-74). Tracheal resection was the most common procedure (13 patients), followed by laryngotracheal reconstruction (7 patients). Fifteen patients began their operation with a tracheostomy, 6 of whom underwent decannulation prior to leaving the operating room. Three additional patients underwent decannulation at follow-up appointments and were prosthesis-free at most recent follow-up. The mean time to decannulation among these patients was 3 months. Of the 14 patients beginning their procedure without a tracheostomy, only 2 required permanent airway prosthesis. The overall long-term rate of prosthesis-free survival was 72.4% (21 of 29 patients). Factors suggestive of long-term success include lower McCaffrey grade and lack of pulmonary disease, hypertension, or diabetes, as well as decreased red blood cell distribution width on preoperative complete blood count. Conclusion Through careful patient selection, preoperative workup, and meticulous postoperative care, airway reconstruction procedures in patients aged ≥60 years are reasonably successful. Of 29 patients, 21 (72.4%) were successfully breathing long-term without airway prosthesis.

Idiopathic Subglottic Stenosis: Long-Term Outcomes of Open Surgical Techniques

2017 ◽  
Vol 156 (5) ◽  
pp. 906-911 ◽  
Author(s):  
Deanna C. Menapace ◽  
Mara C. Modest ◽  
Dale C. Ekbom ◽  
Eric J. Moore ◽  
Eric S. Edell ◽  
...  
Keyword(s):  
Median Time ◽  
Open Surgery ◽  
Voice Quality ◽  
Subglottic Stenosis ◽  
Tracheal Resection ◽  
Open Approach ◽  
Cricotracheal Resection ◽  
Day Range

Objectives Idiopathic subglottic stenosis (iSGS) is rare, and its cause remains elusive. Treatment options include empiric medical therapy and endoscopic or open surgery. We present our results for open surgical technique. Study Design Case series with chart review (1978-2015). Setting Tertiary academic center. Subjects/Methods Thirty-three patients (32 female; median age, 51 years) met inclusion criteria and underwent cricotracheal resection with thyrotracheal anastomosis, tracheal resection with primary anastomosis, or laryngotracheoplasty with rib grafting. Continuous variables were summarized using medians and ranges while categorical features are presented using frequency counts and percentages. Results Sixteen patients (48%) underwent a single-stage approach with immediate extubation or temporary intubation following surgery (median, 1 day; range, 1-3 days). Seventeen patients (52%) underwent a double-staged approach with a median time to decannulation of 35 days (range, 13-100 days). Twenty-four (73%) patients underwent a previous intervention. Median stay in the intensive care unit was 1 day (range, 0-3 days), with a median hospital stay of 4 days (range, 2-7 days). Recurrence requiring further surgical intervention was observed in 12 patients (36%). The median time to recurrence was 8 years over an average follow-up of 9.7 years. The most common complaint following surgery was change in voice quality (fair to poor; n = 10; 30%). Conclusions Open surgery should be reserved for refractory cases of iSGS; cricotracheal resection with thyrotracheal anastomosis is the preferred open technique. Recurrence may occur after open treatment, highlighting the importance of long-term follow-up. Patients should be counseled about the potential for worsening voice quality with the open approach.

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