T-Tube Insertion for Tracheal Stenosis: A Single Centre Experience: 134 Cases

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T-Tube Insertion for Tracheal Stenosis: A Single Centre Experience: 134 Cases

Journal Title: Journal of Cardiovascular Medicine and Surgery - Year 2019, Vol 5, Issue 1

Abstract

Introduction: Tracheal stenosis is a major late complication due to cicatrisation of tracheal wall and is attributed to iatrogenic injury after prolonged intubation and post tracheostomy are well established. In symptomatic patients with benign tracheal stenosis, surgical resection and reconstruction is the optimal standard treatment of choice. Stenting is reserved for symptomatic patients where surgery is not possible due to local or general reasons. Other therapeutic options are dilatation and laser therapy, fulguration, brachytherapy, where therapeutic effects are of short duration and require repeated procedures. Stenting provides prompt and durable palliation to patients who are deemed to be inoperable. The objective of this study was to present our single centre long term experience of Montgomery T-tube in benign stricture as a temporary measure, alternative to definitive surgical reconstruction and also as a palliative management. Patients And Methods: 134 patients underwent tracheal stenting with Montgomery T–tube for benign tracheal stenosis from Jan 1984 to Jan 2018 who were not suitable for definitive primary surgical reconstruction. T-Tubes were positioned under general anaesthesia with Ventilation through rigid bronchoscope. Flexible video bronchoscopic study was performed in all patients at regular intervals of 3 months whereas in few patients, on basis of symptoms, it was repeated as and when required in addition to 3 monthly regular intervals in the first year. On the basis of good effort tolerance and with no symptoms, stoma was closed permanently. Observation and Results: Majority (90%) of patients were of post intubation tracheal stenosis followed by Head injury. Out of 134 patients, 54 (40%) patients were of age group 21-30yrs followed by 36 patients who were of age group 11-20 yrs (27%) with inclination towards male sex (75%). Organophosphorous compound (OP) poisoning was the commonest (48%) cause for prolonged intubation followed by polytrauma and head injury (24%) in our study. Out of 134 patients, 54 (40%) were treated initially with temporary dilatation before T-tube insertion. In 111 (83%) patients T-tubes were removed successfully. Out of these, 65% of patients were free of tubes by 12 -36 months. In 18 (13%) patients, tubes were left as permanent after multiple attempts. They were assessed with bronchoscopy, CT/MR imaging and declared as candidates for permanent T-tube insertion. Excessive granulation tissue in 17 (12%) patients was the major factor for reinsertion of T-tube. Obstruction due to mucus stasis in 8 (6%), cutaneous surgical site infection in 15 (11%), Subcutaneous emphysema in 10 (7.5%), Voice disturbance due to vocal cord oedema in 8(6%) and 5 (4%) patients lost to follow up were expired due to associated co-morbid conditions not related to T-tube insertion in the late post-operative period. Discussion and Conclusion: Ideally, the treatment option should be individualized based on patient characteristics as well as stent selection with serial evaluation of endoscopic data and other radiological methods. The use of silicone stents is a treatment of choice for patients who are not fit for surgery in benign tracheal lesions, as a definitive treatment, a bridge to definitive surgery, a Palliative method and a bridge to future treatments till new therapeutic options are available. Generally, T-tube placement is performed for palliation, proven to give satisfactory therapeutic results in majority of the patients.

Authors and Affiliations

Shivakumaraswamy Siddalingaiah Tumkur

Keywords

T-Tube; Organophosphorous Compound (OP) Poisoning Tracheal Reconstructive Surgery.

EP ID EP655409
DOI 10.21088/jcms.2454.7123.5119.7
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