Outcome and Safety of the Montgomery T-Tube for Laryngotracheal Stenosis: A Single-Center Retrospective Analysis of 546 Cases

Objective: We retrospectively analyzed the surgical outcome and safety of the Montgomery T-tube for laryngotracheal stenosis. Methods: The patients with laryngotracheal stenosis who had undergone T-tube placement between 1996 and 2010 were reviewed. The severity of the stenosis was evaluated using the Cotton-Myer staging method. The primary endpoint was the rate of successful extubation and the secondary endpoint was safety. Results: 546 patients were eligible. T-tubes were successfully extubated in 342 patients 6-24 months following intubation. The initial extubation success rate was 62.3%. Laryngotracheal restenosis following extubation occurred in 192 patients, necessitating T-tube placement for a second time. The success rate for the second attempt was 58.9%. The overall success rate was 83.3%. Hemoptysis was reported in 8 patients, postoperative infection in 6 patients, wound dehiscence in 3 patients, laryngeal obstruction in 13 patients, aspiration in 12 patients, and postoperative tracheoesophageal fistula in 2 patients. Conclusion: This large clinical series demonstrated the safety and effectiveness of the T-tube for grade 1 and 2 stenosis with stenosed segments of <6 cm. For those being >6 cm, tracheal end-to-end anastomosis is not appropriate and long-term placement of a T-tube is recommended. Our findings provide useful guidance for preoperatively selecting patients with laryngotracheal stenosis of various causes and differing severity. (C) 2014 S. Karger AG, Basel