role of tracheal stenting as an alternative treatment in cicatricial and non-operable tracheal stenosis

Tracheal stenosis is normally caused by trauma, infection, benign and malignant tumors, prolonged intubation or tracheostomy. The best treatment for tracheal stenosis is resection and anastomosis of trachea. Yet the major surgical complication of tracheal surgery is postoperative stenosis. The goal of this paper is to study the result of tracheal stenting as a replacement therapy for patients suffering from tracheal stenosis who are not good candidates for surgery. This study presents the results of stenting in patients with: Inoperable tumoral stenosis,Non-tumoral stenosis being complicated due to prior surgeries,Inability to undergo a major surgery. The study was performed between September 2002 and July 2011 and poly flex stents were used by means of rigid bronchoscopy. A total of 25 patients received stents during this study. Among them 15 patients suffered from benign and 10 suffered from malignant tracheal stenosis. The patients were followed up for at most 12 months after the stenting operation. The mean age of the patients was 35 years. The most common cause of stenosis was prolonged intubation [75%]. The most common indication for stenting was the history of multiple tracheal operations. The most common complication of stenting and cause of stent removal was formation of granulation tissue. 30% of patients with benign tracheal stenosis were cured and about 10% improved until they could stand a major operation. Ten patients in benign group and 2 patients in malignant group [20%] needed T-Tube insertion after stent removal but other patientcure by stenting. In benign cases stenting is associated with recurrence of symptoms which requires other therapeutic techniqus, so the stenting may not be named as a final solution in benign cases. However, this technique is the only method with approved efficacy for malignant cases with indication

[Double-lumen endotracheal tube positioning: bag compliance Vs. fiberoptic bronchoscopy]

Lung separation is the basis of thoracic anesthesia, which is performed by different instruments. Checking probable malpositioning of tracheal tube needs fiberoptic bronchoscopy. The aim of this study was to compare respirator suggested compliance with fiberoptic findings in detecting major tracheal tube malpositioning. A total of 256 patients undergoing thoracic surgery with double-lumen tracheal tube insertion in Imam Khomeini Hospital, Tehran, Iran, during 2010-11 were divided into three groups [n=86]. We used left-sided double-lumen tube [DLT] for left or right-sided surgeries [groups 1 and 2], and right-sided DLT for left-sided surgeries [group 3]. The position of the tubes was evaluated and compared using bag compliance versus fiberoptic bronchoscopy. The mean age of the study population was 44.7 +/- 13.4 [16-73] years, while 155 [59.9%] were male. The sensitivity, specificity, positive and negative predictive values, and the accuracy of bag compliance test for left-sided DLT in supine position were 40% [95% CI: 20-60%], 99% [95% CI: 96-99%], 84% [95% CI: 54-94%] 92% [95% CI: 88-95%] and 92% [95% CI: 87-95%], respectively. The above-mentioned variables for lateral decubitus position respectively were 27%, 98%, 76%, 89%, and 88%. Malpositioning was more prevalent in right-sided DLTs [P=0.02]. Based on the results of this study, and the high specificity, positive predictive value, and accuracy of bag compliance test, its use is encouraged as an alternative to fiberoptic bronchoscopy for checking DLT position, specially, in emergent surgeries or when fiberoptic bronchoscopy is unreachable due to lack of expertise or personnel.