Postintubation Multisegmental Tracheal Stenosis, a 24-Year Experience.

Abstract Background Management of Multisegmental Tracheal Stenosis (MSTS) is challenging. In this 24-year longitudinal single-center study, we present an algorithmic treatment approach. Methods A retrospective analysis of 2167 patients with post-intubation tracheal stenosis indicated 83 (3.83%) patients with MSTS. Patients were assigned to four management groups according to the length, location, and severity of stenoses, tracheal infection/mucositis, laryngeal function, symptoms, general condition, and comorbid diseases. Type-1 (n=13): one-stage resection of both strictures, Type-2 (n=6): two-stage resection of both strictures, Type-3 (n=40): resection of one stricture and non-resectional management of the other one, Type-4 (n=24): non-resectional management of both strictures. Outcomes were categorized as Good, Acceptable, or Poor. Univariate analyses for factors predictive of recurrence and outcome were performed. Results Follow-ups were completed in 70 (84.34%) patients (median 22.5 months). Outcome was assessed as Good in 56 (82.35%), Acceptable in 10 (14.71%), Poor in 2 (2.94%), and mortality in 2 (2.94%) patients. The median length of airway resection was 46, 67.5, and 40 mm in Types 1-3, respectively. Only 11 (13.25%) patients had no history of tracheostomy or tracheal surgery. By univariate analysis, a shorter intubation period was associated with Good outcome (p=0.017). No factors predictive of recurrence or outcome were ascertained. Conclusions MSTS, generally caused by performing an inappropriate tracheostomy, is an iatrogenic disease that can be prevented. Although resection of both strictures may be feasible and is associated with Good results, in the majority of cases, a combination of surgical resection and non-resectional methods are sufficient to achieve Good results.