Indications and Utility of Posterior Tracheopexy in the Pediatric Population: An Overview of Its Expanding Role in Tracheobronchial Disease

TL;DR

Posterior tracheopexy is a surgical technique that improves breathing and reduces complications in children with tracheomalacia and those undergoing TEF/EA repair.

Contribution

The paper highlights the expanding role of posterior tracheopexy in treating tracheobronchial disease in pediatric patients.

Findings

Posterior tracheopexy improves respiratory symptoms and reduces ventilatory dependence in patients with tracheomalacia.

Primary posterior tracheopexy during TEF/EA repair may reduce respiratory morbidity and the risk of TM in select neonates.

Multidisciplinary evaluation is essential for optimizing outcomes in patients undergoing posterior tracheopexy.

Abstract

What are the main findings?
Posterior tracheopexy improves respiratory symptoms, respiratory infection rates, and ventilatory dependence in patients with tracheomalacia.Primary posterior tracheopexy during tracheoesophageal fistula/esophageal atresia (TEF/EA) repair may benefit select patients with posterior tracheal intrusion.

Posterior tracheopexy improves respiratory symptoms, respiratory infection rates, and ventilatory dependence in patients with tracheomalacia.

Primary posterior tracheopexy during tracheoesophageal fistula/esophageal atresia (TEF/EA) repair may benefit select patients with posterior tracheal intrusion.

What are the implications of the main findings?
Posterior tracheopexy is a valuable surgical technique for the treatment of tracheomalacia (TM) or the reduction in respiratory morbidity following TEF/EA repair in select neonates.Patient evaluation and follow-up should be conducted by multidisciplinary teams to optimize long-term outcomes in patients with complex tracheal diseases requiring posterior tracheopexy.

Posterior tracheopexy is a valuable surgical technique for the treatment of tracheomalacia (TM) or the reduction in respiratory morbidity following TEF/EA repair in select neonates.

Patient evaluation and follow-up should be conducted by multidisciplinary teams to optimize long-term outcomes in patients with complex tracheal diseases requiring posterior tracheopexy.

Background: Tracheobronchial disease, including tracheomalacia (TM) and tracheobronchomalacia (TBM), is a spectrum of congenital and acquired airway disorders characterized by the collapse of the tracheal or mainstem bronchial walls during expiration, particularly when there are increased intrathoracic pressures. Traditional surgical approaches to treat severe medically refractory TM include anterior approaches, such as aortopexy or anterior tracheopexy. Recently, posterior tracheopexy has emerged to address the widened and mobile posterior tracheal membrane which can cause transient airway obstruction. Method: The National Institute of Health, National Library of Medicine, PubMed, and MEDLINE databases were queried for manuscripts related to posterior tracheopexy in the pediatric population. Preoperative diagnostics, anesthetic considerations, operative technique, clinical outcomes, and operative complications were analyzed in each manuscript. Results: Patients with severe medically refractory cases of TM who are being considered for posterior tracheopexy should undergo thorough preoperative workup by a multidisciplinary team. Cross-sectional, dynamic thoracic imaging and a “quadruple endoscopy”, incorporating laryngoscopy, dynamic bronchoscopy, distal bronchoscopy, and esophagogastroduodenoscopy (EGD) should be obtained as part of a standardized preoperative assessment. Posterior tracheopexy for pre-existing TM significantly improves respiratory symptoms, respiratory infection rates, brief resolved unexplained events, and ventilatory dependence. Recently, posterior tracheopexy during TEF/EA repair has been described and aims to reduce the risk of patients developing TM, the risk of TEF recurrence, and respiratory morbidity following TEF/EA repair. An ongoing randomized controlled trial may help to elucidate the efficacy of primary posterior tracheopexy in select neonates with TEF/EA. Conclusions: Posterior tracheopexy is a valuable surgical technique for the treatment of TM or the reduction in respiratory morbidity following TEF/EA repair in select neonates.

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