Pediatric Tracheal Surgery: A 25-year Review of Slide Tracheoplasty and Tracheal Resection

Abstract Background The purpose of this study was to assess the outcomes of slide tracheoplasty and tracheal resection in pediatric patients and analyze our data for predictors of outcomes. Methods Retrospective review of tracheal surgery from 1/1/1993 to 5/1/2018 was performed. Demographic data, operative details, perioperative data, and clinical outcomes were collected. Our management strategy has evolved over time with less rigid bronchoscopy, more reliance on postoperative computed tomographic imaging, and utilization of inhaled Ciprodex since 2007. Results There were 41 patients with a median age of 4.1 months and median weight of 4.2 kg. There were 6 neonates and 24 infants. Slide tracheoplasty was performed in 27 patients (66%) and resection with end-to-end anastomosis in 14 (34%). Eleven patients (27%) had a pulmonary artery sling. Simultaneous intracardiac repairs requiring cross-clamp and cardioplegia were performed in 9 patients (22%). Lung agenesis (6) or severe hypoplasia (2) was present in 8 patients (20%). Complications included tracheostomy in 5 patients (12%), and in-hospital death in 3 patients (7%). There were no cases of mediastinitis. We use inhaled Ciprodex to decrease granulation tissue at suture lines. Median intubation time was 7 days and median length-of-stay was 25.0 days. There was no difference in outcomes comparing intracardiac repairs with the remaining patients, lung agenesis/hypoplasia versus the remaining cohort, or neonates versus infants. Conclusions Slide tracheoplasty and tracheal resection are effective operative strategies for infants and children with tracheal stenosis including patients with lung agenesis/hypoplasia. We recommend simultaneous repair of intracardiac anomalies and pulmonary artery sling.