Circumferential resection of crico-tracheal stenosis with primary end-to-end anastomosis.

Postintubation injury of the upper airway commonly results in stenotic lesions of the larynx, subglottis, and adjacent trachea. The traditional approach to surgical correction is staged plastic reconstruction. Reported results are variable and unpredictable, and permanent extubation is impossible in a significant number of patients. We present our experience with circumferential crico-tracheal resection with end-to-end anastomosis. Between 1991 and 2002 we performed this procedure on 29 patients with crico-tracheal stenosis. The cause of the stenosis was related to intubation and/or failed tracheotomy in 87% of the patients. Two to 7 tracheal rings were resected and a tension-free anastomosis was achieved with mobilization techniques that were limited to peritracheal dissection. The anastomosis success rate was 96%. Type of the anastomosis was tracheo-thyreopexy in six, tracheo-cricopexy in nine and tracheo-tracheopexy in eight cases. There were no major complications and no compromise of swallowing. This experience suggests that the procedure is relatively safe and effective.