Surgical treatment of long scarred tracheal strictures

This article presents the treatment outcomes of 72 patients with extensive cicatricial tracheal stenosis that developed following prolonged intubation or tracheostomy, primarily due to severe multiple trauma, comatose states, and extended mechanical ventilation. A comprehensive diagnostic approach was applied, including clinical, radiological, functional (spirometry), endoscopic examinations, and multislice computed tomography, which enabled determination of the location, duration, severity of stenosis, and associated pulmonary changes. The main clinical manifestation was progressive respiratory distress, ranging from exertional dyspnea to stridor. Radical surgical intervention – circular tracheal resection with end-to-end anastomosis – was performed in 67 patients. The choice of anastomosis type (tracheotracheal, laryngotracheal, or laryngotracheal with extended resection) depended on the level of stenosis. Surgeries were carried out via cervical access or in combination with upper sternotomy. Particular attention was paid to postoperative prevention of complications, including airway sanitation, intubation technique, head positioning, antibiotic therapy, inhalation, and bronchoscopic support. The complication rate was less than 5.0 %, and mortality was 1.3 %. The majority of patients (94.5 %) were discharged with good clinical outcomes. The findings confirm the effectiveness of timely surgical treatment of cicatricial tracheal stenosis as the only radical method for restoring airway patency. However, in cases of severe comorbidities, significant somatic weakness, or a high risk of reintubation, a delay or modification of the surgical approach may be warranted to optimize patient safety. Early surgical intervention is crucial for optimal outcomes, but requires careful patient selection and preoperative optimization to minimize risks. Keywords: cicatricial tracheal stenosis, surgical treatment, circular tracheal resection.