# Revision tracheal resection anastomosis for recurrent stenosis after airway surgeries: functional outcomes

## TL;DR

This study evaluates the effectiveness of a specific surgical technique for treating airway narrowing after previous surgeries, showing high success rates and improved quality of life.

## Contribution

The study introduces a standardized surgical approach with tension-reducing techniques for recurrent airway stenosis.

## Key findings

- A 92.5% decannulation rate was achieved in 53 patients undergoing revision tracheal/cricotracheal resection anastomosis.
- Postoperative complications occurred in 24.5% of patients, primarily involving restenosis and granulation tissue formation.
- Most patients experienced significant improvement in dyspnea, voice, and swallowing functions.

## Abstract

To evaluate the surgical and functional outcomes as well as the quality of life among patients who underwent revision tracheal/cricotracheal resection anastomosis for recurrent stenosis after previous unsuccessful airway surgeries.

This prospective study was conducted on 53 patients. Circumferential resection of the stenotic airway segment was done with primary end-to-end anastomosis. All surgeries were performed by the authors of this work with the same standardized surgical techniques. To decrease the anastomotic tension, suprahyoid release was performed for all patients and trachea-hyoid detensioning stitches were placed. Surgiflo was applied over the line of the anastomosis to enhance healing. Surgical and functional outcomes were evaluated.

Types of anastomosis were cricotracheal anastomosis (n = 18), thyrotracheal anastomosis (n = 24), and tracheo-tracheal anastomosis (n = 11) according to the remaining proximal and distal stumps. The overall decannulation rate was 92.5% (49 out of 53 patients). No major intraoperative complications were reported. Postoperative complications were reported in 13 patients (24.5%), in the form of restenosis (n = 7), granulation tissue formation at the site of anastomosis (n = 5), surgical emphysema / minor air leak through drains (n = 4), unilateral vocal fold paralysis (n = 2), wound seroma (n = 1). Regarding functional outcomes, dyspnea was considerably alleviated both at rest and during exercise, and most patients had satisfactory voice and swallowing related functions. The majority of patients reported adequate QOL.

Revision tracheal/cricotracheal resection anastomosis presents significant surgical challenges. Nevertheless, by employing meticulous surgical techniques and implementing strategies to reduce anastomotic tension and enhance healing such as suprahyoid release, trachea-hyoid detensioning stitches, and the application of surgiflo, high success rates and satisfactory functional outcomes were achieved.