Surgical Management of Congenital Tracheal Stenosis

Congenital tracheal stenosis, characterised by intrinsic narrowing of the airway due to complete cartilaginous rings or segmental dysplasia of the tracheal cartilage, remains a complex challenge in paediatric surgery. Long-segment stenosis (exceeding half the tracheal length) and short-segment lesions demand differing strategies informed by the extent of airway involvement and associated cardiovascular anomalies. Slide tracheoplasty has become the preferred approach for long-segment disease, enabling circumferential enlargement of the lumen by incisions along adjacent tracheal segments and demonstrating reduced rates of restenosis and granulation compared with patch techniques. Pericardial patch tracheoplasty, while effective for focal narrowing, often necessitates postoperative dilatations or stenting due to granulation tissue formation. Segmental resection with primary anastomosis is reserved for very short lesions but is constrained by tracheal length and anastomotic tension. Concurrent vascular anomalies, most notably pulmonary artery sling, typically require simultaneous reimplantation or translocation of the aberrant vessel. Adjunctive measures such as intrathoracic tissue expander placement to counter mediastinal shift and novel biodegradable stents are gaining traction. Optimal outcomes depend on a multidisciplinary team, advanced imaging—including three-dimensional reconstruction and virtual bronchoscopy—and meticulous peri-operative airway management to minimise complications and support long-term airway patency.

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Surgical Management of Congenital Tracheal Stenosis publication trend

The graph below shows the total number of articles in surgical management of congenital tracheal stenosis across all publications each year (not limited to Nature Index journals).

Technical terms

Slide tracheoplasty: A reconstructive technique in which a stenotic tracheal segment is divided longitudinally and the two halves are slid together to increase luminal diameter.

Pericardial patch tracheoplasty: A method for enlarging a focal tracheal narrowing by suturing an autologous pericardial patch to the defect.

Pulmonary artery sling: A vascular anomaly in which the left pulmonary artery originates abnormally from the right pulmonary artery and encircles the trachea, causing compression.

Intrathoracic tissue expander: A saline-filled implant placed within the chest cavity to reposition mediastinal structures and relieve airway obstruction.

Virtual bronchoscopy: A non-invasive imaging technique that reconstructs the airway lumen from computed tomography data to assess the location and severity of stenosis.

References

1. Tumoral and non-tumoral trachea stenoses: evaluation with three-dimensional CT and virtual bronchoscopy. Journal of Cardiothoracic Surgery (2007).
2. Surgical reconstruction for congenital tracheal malformation and pulmonary artery sling. Journal of Cardiothoracic Surgery (2019).
3. Management of congenital tracheal stenosis. European Journal of Cardio-Thoracic Surgery (2004).
4. Right Lung Agenesis with Tracheal Stenosis due to Complete Tracheal Rings and Postpneumonectomy Like Syndrome Treated with Tissue Expander Placement. Case Reports in Pulmonology (2016).
5. Management of Tracheal Diseases in Children. Frontiers in Pediatrics (2020).
6. Case report: a step-wise management of concurrent presentation of congenital single lung and aberrant right subclavian artery in an infant girl. Journal of Cardiothoracic Surgery (2021).
7. Partial Anomalous Left Pulmonary Artery Anterior Versus Posterior Types: A Systematic Review. Tomography (2022).
8. Left pulmonary artery sling: why is virtual CT bronchoscopy important? Case report. Egyptian Journal of Radiology and Nuclear Medicine (2023).