• Journal of Chest Surgery
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• v.25 no.11
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• pp.1299-1304
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• 1992

We experienced 5 cases of tracheal stenosis and 7 cases bronchial stenosis treated surgically at the Department of Thoracic and Cardiovascular Surgery, School of Medicine, Hanyang University during 5 years. The causes of tracheal stenosis were prolonged endotracheal intubation 1 case, tracheostomy 1 case, the sequela of endobronchial tuberculosis 2 cases and tracheomalacia 1 case. The causes of bronchial stenosis were all endobronchial tuberculosis. The managements of tracheal stenosis were tracheal resection and end to end anastomosis. The resected lengths of trachea were 1.5cm, 3cm and 7.5cm. One case of suglottic stenosis was underwent the resection of trachea, 8cm in length, and the laryngotracheal anastomosis was done, but the re-stenosis of trachea was developed after 4 weeks post-operatively. One case of tracheomalacia was done permanent tracheostomy only, because the entire trachea was adhered to the surrounding tissue. The managements of bronchial stenosis were resection of involved lobe or one lung, in the 5 case. One case with Lt. main bronchial stenosis and atelectasis of Lt. upper lobe was done the lobectomy of Lt. upper lobe only and then, the Lt. pneumonectomy was done re-operatively because the atelectasis of Lt. lower lobe had continued. The other one case with stenosis of Rt. main bronchus, failed the insertion of metalic stent, was underwent the Rt. upper lobe lobectomy, sleeve resection and side to end anastomosis

• Journal of Chest Surgery
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• v.24 no.8
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• pp.765-772
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• 1991

Between 1985 and 1990, 41 patients underwent treatment of the tracheal stenosis. Nineteen patients underwent resection and end-to-end anastomosis including three cases of the subglottic stenosis. Other patients had had treatment such as LASER therapy, bronchoscopic removal, insertion of the Montgomery silastic T-tube or stent insertion Nineteen patients which underwent resection and end-to-end anastomosis were excellent result from three years to sixth months. Other patient were followed at OPD for the other complication or restenosis. There were no hospital death but one patient was managed by bronchoscopic removal of the granulation tissue and other one patient had underwent reoperation for the dehiscence at the anastomotic site.

• Korean Journal of Bronchoesophagology
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• v.3 no.1
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• pp.94-100
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• 1997

Background and Objectives : In children with tracheal stenosis, operative management remains a challenging problem due to difficulties of operative techniques and postoperative care. The purpose of this study was to determine the effectiveness of tracheal resection with end to end anastomosis as operative management for tracheal stenosis in children. Materials and Methods : 6 children with severe tracheal stenosis underwent tracheal resection with end to end anastomosis. Causes of stenosis were trauma in 1 case and prolonged intubation or tracheotomy in 5 cases. The diagnoses were made by radiologic evaluation (plain X-ray, CT, 3-Dimensional CT) and confirmed by direct laryngoscopy and ventilating bronchoscopy under general anesthesia. Thyroplasty and unilateral arytenoidectomy were performed in 1 case. Suprahyoid release was done in 1 case with severe adhesion. Decanulation was achieved following postoperative endoscopic examination and pulmonary function test. Postoperative physical and radiologic examinations were given at regular intervals. Results : Stenosis were improved from grade III grade I in 4 cases and from grade II to grade I in 2 cases. Decanulation was achieved on average postoperative 6 months in 5 cases, and 10 years in 1 case due to exertional dyspnea. There were 1 each case of immediate postoperative subcutaneous emphysema, pneumothorax and wound infection. Postoperative granulomas at anastomosis site were treated with laser vaporization under suspension laryngoscope and bronchoscope in 3 cases. There was 1 each case of delayed postoperative vocal cord palsy, aspiration pneumonia and loss of cough reflex. Conclusion In tracheal stenosis of children, tracheal resection with end to end anastomosis has good result with preservation of normal airway. Preoperative evaluation of local factors such as swallowing, vocal cord movement and cough reflex and general condition was important for successful treatment. As the cases in adults, authors considered this operation to be a curable operative management for tracheal stenosis.

• Korean Journal of Bronchoesophagology
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• v.1 no.1
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• pp.94-100
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• 1995

Despite improvement in respiratory care, including widespread use of low pressure and high volume cuffed tubes, tracheal stenosis remains a feared complication of prolonged intubation and tracheostomy. In such patients, other coexisting problems such as vocal cord paralysis, tracheoesophageal fistula, noncontiguous stenotic segments and laryngeal stenosis may occasionly be encountered. Therefore tracheal stenosis still presents a significant management problem, despite recent endoscopic advances and surgical techniques. Between 1991 and 1994, authors preformed tracheal resection with end-to-end anastomosis on 11 patients with tracheal stenosis. The total success rate (asymptomatic patients with patent airway) was 72.7% and there were no serious complication. This report reviews our experience about this procedure and surgical results. And it investigates associated factors for successful results.

• Journal of Chest Surgery
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• v.22 no.5
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• pp.834-838
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• 1989

Tracheal stenosis is being encountered more frequently as ventilatory support and cuffed tubes are increasingly used for treatment of respiratory failure. We experienced 13 cases of tracheal stenosis treated surgically at department of Thoracic and Cardiovascular Surgery, school of medicine, Kyung Hee university during the 4 years. The causes of tracheal stenosis were prolonged endotracheal intubation 5 cases, tracheostomy 3 cases, tracheal tumor 2 cases, thyroid tumor 1 case and congenital double aortic arch 1 case. The methods used to manage the tracheal stenosis were tracheal resection % end to end anastomosis 8 cases, 2 cases of subglottic stenosis were underwent primary laryngotracheal anastomosis, Lt. aortic arch division 1 case, and stent insertion 2 cases. In two cases, who had 6 cm in length of tracheal stenosis, we were underwent tracheal resection k end to end anastomosis with supralaryngeal release procedure. Postoperative courses were uneventful except one case with tracheal tumor.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1993.05a
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• pp.81-81
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• 1993

Tracheal stenosis in children are often the result of prolonged intubation and its treatment depends on the severity and extent of the involved segment. Repeated surgical endoscopic procedures may be indicated in those with mild stenoses mainly consisting of granulation tissues, However, surgical reconstruction of the airway should be performed in patients with severe, extensive stenoses composed of mature scar tissue. The senior author has successfully managed such patients with cartilage graft augmentation and tracheal resection anastomosis. This is a presentation of 9 pediatric patients with tracheal stenosis who have been successfully treated by resection anastomosis. The details of the cases and indications for this type of surgery are discussed.

• Korean Journal of Bronchoesophagology
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• v.4 no.1
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• pp.15-26
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• 1998

The first successful transthoracic esophagectomy and intrathoracic esophago- gastric anastomosis reported in 1938. Stomach, small intestine, and colon as well as free revascularized grafts have been substituted for excised esophagus. During the past 60 years, there have been substantial advances in preoperative assessment, nutritional support, anesthetic and operative techniques, and postoperative care of patients undergoing esophageal resection and reconstruction. However the hospital mortality and morbidity of esophageal resection and reconstruction is still high and disruption of an intrathoracic esophagogastric anastomosis continues to be the most dreaded complication of esophageal surgery, And the choice of the conduit is still controversial. In this paper, I would like to review the current surgical options available to patients who require esophageal resection and reconstruction as well as the advantages and disadvantages of each technique.

• Journal of Chest Surgery
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• v.10 no.1
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• pp.17-24
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• 1977

The present treatment of respiratory failure, using cuffed endotracheal and tracheostomy tube has produced, apparently with increasing frequency, three lesions which have serious ceminical manifestations such as tracheal stenosis, tracheomalasia, and localized tracheal erosion. Extensive resection and reconstruction of the trachea must be necessary because conservative treatment has generally failed in the fully developed stenotic lesion. of the mediastinal trachea following extensive resection is best accomplished by direct anastomosis of the patient`s own tracheobronchial tissue. Any replacement of the mediastinal trachea must be air tight and laterally rigid, and must heal dependably. A variety of materials has been used for substitution following circumferential excision of tracheal segments within the mediastinum. These attempts have often failed because of early leak or late stenosis. We have successfully performed circumferential resection and primary end-to-end anastomosis of the trachea for 4 cases of post-intubation tracheal stenosis located a few centimeter below the tracheostomy stoma in the period of 3 years between 1974 and 1976. The lesion in one patient was found in the upper trachea which was approached anteriorly through a cervicomediastinal incision with division of the upper sternum. Other three located in the lower half of the trachea were operated through a high transthoracic incision with appropriate hilar mobilization in addition to cervical flexion for the development of the cervical trachea into the mediastinum. There were no hospital death, but suture line granulations occurred in two patients were managed by bronchoscopic removal of granulations without difficulties.

• Journal of Chest Surgery
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• v.28 no.2
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• pp.156-161
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• 1995

Although there are many kinds of method in treatment of tracheal stenosis, tracheal resection and primary anastomosis can be performed for management of various kinds of tracheal stenosis because it is considered the most anatomical ideal therapeutic modality. During a 10-year period we performed 18 tracheal resection on 18 patients with no operative mortality and some morbidity. 13 patients had tracheal stenosis caused by endotracheal intubation [eight patients or tracheostomy [five patients ; and five patients caused by a variety of neoplastic lesions [four primary and one secondary . The length of tracheal stenosis were various from 1.5cm to 5.5cm and site of tracheal stenosis were cervical[17patients and thoracic [one patient . Operative techniques were tracheal resection and primary anastomosis[18 patients and additional procedures were cricoid cartilage reconstruction with costal cartilage [one patient , primary repair of esophagus[one patient and suprahyoid laryngeal release technique[eight patients without any complications. We have eight complications; tracheal restenosis were developed in five patients[growth of grannulation tissue at anastomotic site in three patients, delayed restenosis in two patients , anastomotic disruption in one patient, hoarseness and pneumonia in each of two patients. We managed tracheal complications with T-tube insertion in two patients, permanent tracheostomy in three patients and insertion of Gianturco tracheal stent in one patient, but tracheal stent did not reveal good result because it caused persistent production of sputum. We concluded that it is necessary to access full length of normal trachea including suprahyoid laryngeal release technique to avoid anastomotic tension in tracheal surgery and develope new ideal techniques to manage postoperative tracheal complications, because we suppose tracheal complications are developed due to anastomotic tension.

• Journal of Chest Surgery
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• v.13 no.4
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• pp.496-496
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• 1980

A 37 year old male patient was suffered from severe labored breathing caused by post tracheostomy stenosis, which was localized at the mediastinal trachea [cuffed tracheal stenosis] and ranged 1.5 cm in length and approximately 3 ram. in diameter on tracheogram. After dilation of tracheal stenosis with dilator, endotracheal intubation was tried for induction of anesthesia and control of respiration during operation. A tube was placed just beyond the tracheal stenosis without respiratory difficulty. Under the endotracheal anesthesia, circumferential resection of the mediastinal trachea containing the stenosis, approximately 2 cm in length [4 tracheal rings}, was carried out and primary direct end to end anastomosis was performed with interrupted submucosal sutures [3-0 Dexon] and mobilization of trachea Postoperative tracheostomy was not performed. The patient was completely relieved from dyspnea immediately after operation. Post-operative convalescence was entirely uneventful and at present, about 3 months after operation, he is now conducting a usual life. From the literature and our experience, the etiology and treatment of post-tracheostomy stenosis were discussed.