Improving the Outcome of Management of Pediatric Laryngotracheal Stenosis: The Experience of a Tertiary Care Center

Abstract

Introduction:Pediatric laryngotracheal stenosis (LTS) is a challenging problem that imposes a significant burden on patients, their families, and the health care systems. Every effort should be made to optimize the perioperative factors that influence the surgical outcome. The aim of this study is to review the experience of a tertiary care university hospital in management of LTS and to propose recommendation to improve the outcome of pediatric LTS at the study institution.Methods:A retrospective review was conducted on pediatric patients with acquired LTS managed in our tertiary care university hospital between 2016 and 2021. Demographic data, relevant medical and surgical history, preoperative, operative, and postoperative data were collected and analyzed, with a focus on the decannulation rate and the total number of procedures.Results:The records of 46 pediatric patients were reviewed. Prolonged intubation was the main cause of LTS. The outcome of endoscopic management using rigid bronchoscopic dilatation was not different from endoscopic balloon dilatation EBD). Early lesions with soft granulation tissue responded better to endoscopic management and had a better outcome than chronic fibrotic scar. The total number of procedures increased when open surgery was performed.Conclusion:LTS is still a challenging disease entity that requires every effort to optimize the patient’s outcome. Early treatment in the soft incipient stenosis stage has a more favorable outcome. Establishing patient’s care in a tertiary multidisciplinary center, preoperative microbial screening, and proper management of comorbidities are among the recommended measures to improve the outcome of these patients.