The evaluation and surgical management of post-intubation tracheal strictures at a thoracic surgery referral centre in South Africa
Background. The surgical treatment of tracheal stenosis following endotracheal intubation or tracheostomy is well described in the developed world.
Objectives. To describe our surgical experience with this pathology, and highlight the nuances of its diagnosis and management in South Africa.
Methods. We reviewed the clinical records and archived imaging of all patients who underwent tracheal resection and reconstruction for post-intubation tracheal stenosis between 1 July 2003 and 31 July 2014 in the Department of Cardiothoracic Surgery at Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
Results. During the study period, 42 patients underwent tracheal resection. We evaluated the preoperative bronchoscopic characteristics of the tracheal stricture in all patients, and computed tomography (CT) was used as an adjunct in 28 (66%) patients. The stricture lengths determined by CT and intraoperative measurement were strongly correlated (r (27)=0.506, p=0.006), and the stricture lengths determined by bronchoscopy and intraoperative measurement were weakly correlated (r (41)=0.201, p=0.209). A total of 36 patients (85.7%) underwent surgery via a cervical approach and 6 (14.3%) via a right thoracotomy approach. There was no early mortality, and surgery was complicated by vocal cord palsy in 4 cases, restenosis in 2 cases, infection in 1 case and paraparesis in 1 case.
Conclusions. Tracheal resection for the treatment of post-intubation tracheal stenosis can be undertaken safely with minimal complications in the developing world, with the vast majority of lesions approached via a cervical approach. A preoperative evaluation of the stricture using CT is an accurate technique for planning tracheal resection and reconstruction.
S Ramghulam, Department of Cardiothoracic Surgery, School of Clinical Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
R Perumal, Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa;Department of Pulmonology and Critical Care, University of Cape Town, South Africa
D Reddy, Department of Cardiothoracic Surgery, School of Clinical Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
Full Text:PDF (482KB)
Cite this article
Date published: 2018-06-21
Full text views: 181
- There are currently no refbacks.
African Journal of Thoracic and Critical Care Medicine| Online ISSN: 2617-0205
Our Journals: South African Medical Journal | African Journal of Health Professions Education | South African Journal of Bioethics and Law | South African Journal of Child Health | Southern African Journal of Critical Care | South African Respiratory Journal | South African Journal of Obstetrics and Gynaecology |