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An Innovative Method Of Preventing Stent Migration In High Tracheal Stenosis

1168 words - 5 pages

Introduction:

Tracheobronchial disorders can be caused by malignant or benign tumors, extrinsic compression, postintubation tracheal injuries, tracheobronchomalacia, or sequelae after tracheostomy[1]. Tracheobronchial prostheses also known as airway stents are used to palliate the effects of large airway obstruction[1]. Over the time, stent placement have become the most important and fundamental therapeutic intervention to treat the tracheal stenosis in the present world. The application of tracheal stents in the treatment for tracheal stenosis have been further enhanced Cicatricial and Non-Operable Tracheal Stenosis[2]. However, tracheal stents sometimes present with complications like ...view middle of the document...

Patients were put under general anesthesia. Stents were either inserted with rigid bronchoscope and stent applicator set or the caudal displaced stents were pulled up. Anterior surface of the neck was draped in sterile fashion. Under video-bronchoscopic guidance, an 18 gauze needle was inserted percutaneously, piercing skin, subcutaneous structures, anterior wall of tracheal muscles and anterior wall of silicone stent. An ethilon suture was passed through the needle. The crucial point at this stage was to take this suture back through the stent to the exterior. For this a cannula was inserted, at least 1 cm proximal to the needle. A retrieval loop was inserted through this cannula. With the help of the bronchoscope forceps, the suture material was pulled inside the loop. Also we made sure that the length of suture material which was pulled inside the loop to be adequate, so that it can be conveniently pulled out from the second end. Then retraction loop was pulled out from the exterior, bringing the suture material along with it to the external surface. The knot was completed with 2 ends of the suture material and embedded in the subcutaneous tissue.
While removing the stent, the suture was cut with the help of the endoscopic scissor which was passed through the bronchoscope. Suture material was then removed externally and then stent was removed.

Results:

Over 2 years, 31 stent stitches have been performed in 19 patients. Out of these 19 patients 13 were males and 6 were females. Mean age was 37.3±16.5 years. In these 19 patients, stitches have been performed 3 times in 3 patients and 2 times in 6 patients. In these 31 stents, 30 were silicone stents and 1 was metal stent. Diagnosis of these include post intubation tracheal stenosis (26/31), Malignancy (3/31) and trachea-esophageal fistula (2/31). The length of the stents were decided based on the width of airway stenosis. The mean length of the stents which were used is 4.7±1.2 cm. The diameter of the silicone stents used were 13, 15 and 16mm and the metal stent was 18mm, details of which are discussed in table I. We also noted the distance of the upper border of the stent from the vocal cord. This was important to determine the points where the needle and the cannula were need to be passed. These details are discussed in table II. The procedure was successful in 30 patients (96.8%), where in 1 patient it failed due to stitch cutting through. Other minor complications observed were delayed healing of the skin in 2 patients (6.45%).

Conclusion:

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