Evaluation of the Factors Responsible for the Recurrence of Post Intubation Tracheal Stenosis after Resection and Anastomosis

A few number of post-intubation tracheal stenosis recur following resection and anastomosis. Several factors appear to be responsible for recurrence but there is insufficient data available in this regard. In this study we assessed the factors responsible for the recurrence of post-intubation tracheal stenosis after resection and anastomosis in a large group of patients who were operated in our center by one surgical team.

All patients who underwent tracheal and/or subglottic resection and anastomosis due to post intubation tracheal stenosis, at our center during 1995-2006 were divided into two groups (case and control). The study group consisted of patients who had developed recurrence while the controls had no recurrence. The diagnosis of the recurrence was made based on the presence of clinical signs or symptoms and bronchoscopic confirmation. The following variables were compared in both groups: Age, sex, duration of intubation, the reason for intubation, period of time between intubation and surgical operation, history of previous tracheotomy, previous therapeutic interventions such as laser therapy, subglottic involvement, length of resection, presence of tension at the site of anastomosis and the development of surgical site infection. This was a case - control study and statistical analyses were performed using SPSS 15.

Four hundred ninety-four patients underwent resection and anastomosis (365 women and 129 men) with a mean age of 25-34 years (in the range of 4 months to 83 yrs.). Fifty-two patients (10.5%) developed recurrence. Length of resection (mean 42.8 mm in the case group versus 37.8 mm in the control group; P=0.012), the presence of tension at the site of anastomosis (32.7% versus 19.3%; P=0.03), the development of infection at the site of operation (18.2% versus 5%, P=0.006) and subglottic involvement (36.5% versus 19.2%, P=0.005) were higher in the case group and it seems that these factors are responsible for the recurrence.

In this study, the factors responsible for increasing the recurrence rate of post- intubation tracheal stenoses were long lengths of resection, presence of too much tension at the site of anastomosis, wound infection and subglottic involvement. We believe that the surgeon can play an important role by decreasing tension, preventing infection, and preserving subglottic structures.