Results of Surgical treatment for postintubation airway stenosis, in 901 patients

Although resection and anastomosis [RA] is known as most efficient method for treatment of post-intubation airway stenoses, non-resectional methods are being developed and suggested as substitutes for RA. Presenting our experience with sufficient number of patients who underwent resection might be helpful in comparison and selection of various treatment methods. All patients who had been referred to us [Feb 1994 to Jan 2007] underwent bronchoscopy and evaluation of the stricture and function of the larynx. Patients in good general condition whose strictures were operable by RA underwent this operation. Other patients underwent non-resectional treatments. Three types of operations were performed 1] tracheal resection 2] resection of trachea and anterior arch of cricoid 3] resection of trachea and anterior arch of cricoid associated with posterior cricoidotomy and autologous cartilage grafting at the site of cricoidotomy. Surgical results were categorized into good, acceptable and failure. Results were analyzed using SPSS software with Chi-square and Fisher's exact tests. Nine hundred one patients underwent treatment during 13 years out of which, 571 underwent RA [420 men, 151 women, mean age 25.6 yrs]. Types 1, 2 and 3 operations were performed on 451, 88 and 32 patients, respectively. Results were good in 434 [76.10%], acceptable in 79 [13.84%] and failure in 53 [9.29%] patients. Thirteen deaths occurred after resectional treatment and 25 deaths after non-resectional treatments. Single-stage resection and anastomosis is an appropriate treatment for most cases of post-intubation tracheal and laryngotracheal stenoses

Ligation of the major mediastinal vessels, safety and complications

Background: During upper mediastinal surgical interventions, innominate vessels may be ruptured inadvertently or divided intentionally by the surgeon for a better exposure. The question, whether a divided innominate artery or vein should be reconstructed or not, has not yet been clearly answered

Materials and Methods: In a retrospective study, 11 patients who underwent surgery between 1996 and 2004 in our department [7 females and 4 males] with mean age of 38.7 years old were found undergoing an upper mediastinal surgery with ligation of a great vessel. Fourteen great vessels [6 innominate arteries, 4 left innominate veins, 3 right innominate veins and one right carotid artery] were ligated with no reconstruction. The vessels were intentionally divided for a better exposure or ligated for controlling of severe bleeding [due to an iatrogenic trauma] in 6 and 5 patients, respectively

Results: One patient with innominate artery and right innominate vein division suffered from a 48 - hour period of coma due to a cerebral edema which was completely resolved. Two patients developed infection at the site of sternotomy and were managed with antibiotics and wound care. No complication occurred in the remaining. In two cases with division of innominate arteries, the peripheral pulses disappeared, but there was no muscle weakness, or ischemic pain in the limb. The follow-up period was between 2-96 months [mean; 24.8]

Conclusion: In critical condition and when surgical situation is not suitable for reconstruction, innominate vessels could be safely ligated and divided for a better surgical exposure and control of bleeding; with acceptable post-op risks