Hybrid resection in upper tracheal stenosis: balancing unequal diameters through sliding technique: A five-year single-center experience

Purpose Segmental tracheal resection with primary end-to-end anastomosis is the standard treatment for benign upper tracheal stenosis; however, proximal–distal luminal diameter mismatch may increase anastomotic tension and predispose to restenosis. We evaluated the feasibility, safety, and clinical outcomes of a hybrid tracheal resection with sliding technique designed to improve airway caliber while maintaining low anastomotic tension. Methods A retrospective cohort study was conducted including consecutive patients who underwent hybrid tracheal resection with sliding technique for upper tracheal stenosis between January 2019 and December 2023. The technique was selectively used in cases with anticipated diameter mismatch based on clinical and intraoperative assessment. The primary outcome was primary surgical success, defined as decannulation without the need for additional airway intervention. Secondary success was defined as achievement of a stable airway following adjunctive endoscopic treatment Secondary outcomes included perioperative morbidity, restenosis, and hospital stay. Results Fifteen patients were included (mean age 25.3 ± 6.1 years; 60% male). The most common etiology was post-intubation stenosis (60%). Mean stenosis length was 2.3 ± 0.6 cm and mean resection length was 2.6 ± 0.5 cm. Mean operative time was 152 ± 17 min and mean hospital stay was 9.1 ± 2.3 days. Complications occurred in 6 patients (40.0%; 95% CI, 16.3–67.7%), predominantly minor. Restenosis requiring endoscopic balloon dilatation developed in 2 patients (13.3%; 95% CI, 1.7–40.5%). Primary surgical success was achieved in 86.7% of patients. Two patients required adjuvant endoscopic intervention and ultimately achieved secondary success with a stable airway at final follow-up. No anastomotic dehiscence or mortality occurred. Conclusion Hybrid tracheal resection with sliding technique appears to be a feasible and safe reconstructive option for selected patients with short-segment upper tracheal stenosis and diameter mismatch. This approach may facilitate tension-free anastomosis and satisfactory airway outcomes. However, these findings should be interpreted cautiously given the retrospective design, small sample size, and absence of a comparator group.