[Repeated tracheal resection for non-neoplastic restenosis].

Treatment of patients with recurrent cicatrical tracheal stenosis after previous circular tracheal resection is one of the most difficult problems in thoracic surgery at present time. In most cases repeated radical surgery as new resection is declined in favour of palliative treatment. It is often associated with lingering or perpetual preserving of T-shape or tracheostomy tube and respiratory tract stenting. Development of thoracic surgery last years permits to perform repeated tracheal resections with restoration of respiratory tract integrity by using of new tracheal anastomosis. For the last 4 years 6 such operations were performed with satisfactory immediate and remote results. Diagnostic algorithm before repeated surgery is similar to those before primary intervention. Special attention should be attended to state of remained parts of respiratory tract, degree and length of stenosis and tracheomalacia which may be result of divergence of edges of the primary anastomosis. Preserving of not less than 1/4 primary length of intact trachea with its satisfactory mobility is main condition for this surgery because it will permit to perform new anastomosis without high tension. Risk of postoperative complications after repeated operations is not higher than those after primary resection. But at present time these operations are in competence of small number of specialists and medical institutions with serious experience in thoracic surgery.

[Simultaneous resection of the two tracheal fragments for cicatrical stenosis].

Treatment of multifocal and extended tracheal stenosis is associated with considerable difficulties in comparison with local lesions. Resection with restoration of respiratory lumen by using of direct intertracheal anastomosis substantially entered into common clinical practice. But these interventions in patients with two-level lesion are performed rarely. Among 900 operated patients with cicatrical tracheal stenosis resection of two tracheal segments with forming of anastomoses was performed only in 5 patients. We presented an experience of single-stage resections of different segments of respiratory tract for nonneoplastic cicatrical stenosis. Indications and contraindications are defined. Technical features of resection are discussed. Our data show that such operations are possible and safe. All patients recovered. Their breath was completely restored. Risk of postoperative complications after similar operations is not higher than after one-level resection. But at present time these techniques may be used by specialists and institutions with serious experience in tracheal surgery.

[Surgical approaches in surgery for cicatrical tracheal stenosis].

At present time several surgical approaches are being used for cicatrical tracheal stenosis including cervicotomy, longitudinal- circumferential sternotomy and thoracotomy. Besides location of stenosis an approach is being determined by constitutional and anatomical features of patient, surgeon's and anesthesiologist's experience, well-coordinated work of operating team. If pathological process is placed in cervico-laryngeal, cervical and upper thoracic segment cervicotomy is preferable. Partial longitudinal-circumferential sternotomy is believed to be adequate in case of lesion of thoracic trachea and its bifurcation. This approach provides all types of tracheal reconstructions. Technical difficulties appear if process is localized in membranous wall of suprabifurcational part, bifurcation and primary bronchus. In these cases we recommend thoracotomy through the bed of resected the 3rd or the 4th ribs and patient's position on his front. Interventions including pulmonary tissue resection and tracheal edges convergence are possible through thoracotomy.

[Surgical stapling instruments in surgical treatment of non-neoplastic tracheoesophageal fistula].

The experience of treatment of 118 patients with non-neoplastic tracheoesophageal fistulas is presented in the article. Radical surgeries was performed in 85.6% cases, palliative operations - in 4.2% of patients. Conservative therapy was rare (12 patients). The volume of radical interventions was different. There was volume increase in case of concomitant tracheal stenosis or involvement in process adjacent organs and tissues. It is frequent situation last years. Surgical stapling instruments were used in 62 patients during surgery. Domestic (UKS-20, UKS-30, UO-40, UO-60) and import instruments were applied. Postoperative complications were diagnosed in 32.7% of patients. The most complications were determined with exacerbation of inflammation in lungs (exacerbation of purulent bronchitis, pneumonia, etc.). It was not revealed complications determined with surgical stapling instruments using for tracheal or esophageal defects removal in any patients. Relapse in long-term period was observed in 10 radically operated patients. All of them underwent tracheoplastic surgeries on the cervical and thoracic trachea except tracheoesophageal fistula separation. Clearance of the respiratory tract was formed by using of T-tube in the future. Surgical stapling instrument was used only in 2 of these patients during radical surgery. 7 patients were re-operated for tracheoesophageal fistula relapse with good result.