Anastomotic complications after tracheal resection for post-intubation tracheal stenosis

Background: The most common cause of tracheal stenosis is prolonged intubation. The best surgical treatment is tracheal resection with end to end anastomosis. The purpose of this study was to determine the factors related to anastomotic complications (restenosis, granulation tissue and tracheal dehiscence), after tracheal resection. Methods: All patients with post intubation tracheal stenosis that underwent tracheal resection in a third degree hospital during a five year period were included. Of all patients' demographic data, days of intubation, co-morbidities (diabetes mellitus, high blood pressure, renal deficiency, and cardiopathy), and use of anticoagulants were obtained. Also requirement of previous airway procedures (tracheal dilatations or tracheostomy) were recorded. Of the operative data, the location and length of the stenosis and if larynx liberation man oeuvre were required. The follow-up was for at least 6 months to identify complications of the anastomosis. Results: There were 71 patients, 46 of the men (65%), with a mean age of 42 years. The mean days of intubation was 15 (3-90). Twenty-three (32.3%) of them required tracheostomy or tracheal dilatation prior to definitive surgical treatment. During the follow-up twelve patients (17%) developed re-stenosis, five (7%) granulation tissue in the anastomosis, and one (1%) tracheal dehiscence. Of the factors studied only resection of stenosis longer than 3 cm was significant (p< 0.01). Conclusions: Our findings suggest that excessive tension of the anastomosis, and devascularization of the trachea are factors related to anastomotic complications, after tracheal resection for post intubation stenosis.