Pediatric tracheal surgery.

BACKGROUND: Pediatric tracheal procedures are uncommon. We reviewed our experience to clarify management and results.

METHODS: Retrospective single-institution review of pediatric tracheal operations, 1978 to 2001.

RESULTS: One hundred sixteen children were evaluated, mean age 10.4 years (10 days to 18 years). Tracheal pathology was postintubation stenosis (n = 72; 62%), congenital stenosis (n = 23; 20%), neoplasm (n = 8; 7%), tracheomalacia (n = 7; 6%), and trauma (n = 6; 5%). Twenty-nine patients had previous tracheal operations. Thirty-six patients received only a minor procedure. Eighty patients had major operations: tracheal resection (n = 46; 58%), laryngotracheal resection (n = 22; 28%), slide tracheoplasty (n = 7; 9%), and carinal resection (n = 5; 6%). The mean length of airway resected was 3.3 cm (1.5 to 6 cm), which represented 30% of the entire trachea. Twenty-eight patients (35%) had complications. These included tracheomalacia (n = 3), recurrent nerve injury (n = 3), laryngeal edema requiring intubation (n = 2), stroke (n = 1), esophageal leak (n = 1), and lobar collapse (n = 1). Nineteen patients had anastomotic failure: severe restenosis (n = 6), mild restenosis (n = 9), dehiscence (n = 2), dehiscence with tracheoesophageal fistula (n = 1), and tracheoinnominate fistula (n = 1). Two children died (2.5%). Complications were more frequent in children less than 7 years of age (p = 0.05) and after previous operations (p = 0.02). Longer fractions of tracheal resection (> 30%) were more likely to result in anastomotic failure (p = 0.0005). Sixty-four (80%) patients achieved a stable airway free of any airway appliance. All patients with neoplasms are alive.

CONCLUSIONS: The principles of adult tracheal operations are directly applicable to children and usually lead to a stable, satisfactory airway. Children tolerate anastomotic tension less well than adults; resections more than 30% have a substantial failure rate.