Factors Associated With Staged Reconstruction and Successful Stoma Closure in Tracheal Resection and End-to-End Anastomosis

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Abstract
Background By analyzing the rate of successful decannulation in patients who underwent tracheal resection and end-to-end anastomosis, we tried to find the factors affecting the surgical outcome of tracheal stenosis. We also tried to discover the factors affecting the need for staged reconstruction. Design and Setting Retrospective study in a tertiary care center. Patients From 1988 to 2001, 117 tracheal resections and primary end-to-end anastomoses in 110 patients were carried out. The statistical analysis was done from the data of 81 patients in whom the stenosis was caused mainly by internal trauma such as long-term intubation or tracheostomy. Main Outcome Measures The success of surgery was defined as successful stoma closure; staged reconstructions were defined as cases in which the stoma was left open intentionally during the end-to-end anastomosis. Results The stoma could be successfully closed primarily in 67 (83%) of the 81 cases, and staged reconstructions were needed in 22 (26%) of the patients. Older patients (>60 years) and patients with a higher grade of stenosis showed a significantly lower success rate. Staged operations were more frequently needed in cases with total stenosis and with combined stenosis of the trachea and the subglottis. Conclusions In patients older than 60 years or with severe stenosis, the rate of successful stoma closure was low. A staged operation should be considered in cases with severe stenosis or stenosis not confined to the trachea.