Name of the Procedure:

Tracheoplasty; intrathoracic
Common names: Intrathoracic tracheoplasty, Tracheal reconstruction

Summary

Tracheoplasty is a surgical procedure performed to repair or reconstruct the trachea (windpipe) that lies within the chest (intrathoracic). This is done to address narrowing, blockage, or damage to the trachea, ensuring the patient can breathe more easily.

Purpose

• Medical condition or problem: Tracheal stenosis (narrowing), tracheomalacia (weakness), tracheal tumors, or trauma to the trachea.
• Goals or expected outcomes: To restore normal airflow through the trachea, alleviate breathing difficulties, and improve the patient’s overall quality of life.

Indications

• Symptoms: Difficulty breathing, wheezing, frequent respiratory infections, and stridor (a high-pitched wheezing sound during breathing).
• Criteria: Patients with significant intrathoracic tracheal narrowing or obstruction that does not respond to less invasive treatments.

Preparation

• Pre-procedure instructions: Patients may be advised to fast for several hours before the surgery. Medications, especially blood thinners, might need to be adjusted.
• Diagnostic tests: Imaging studies like CT scans or MRIs, and bronchoscopy to visualize the trachea.

Procedure Description

1. Anesthesia: General anesthesia is administered to keep the patient unconscious and pain-free.
2. Incision: A surgical incision is made in the chest to access the trachea.
3. Repair/Resection: The surgeon removes the narrowed or damaged part of the trachea and reconnects the healthy ends (anastomosis). If necessary, a tracheal stent or graft may be placed.
4. Closure: The incision is closed with sutures, and the patient is moved to the recovery area.

Duration

The procedure typically takes 3-6 hours, depending on the complexity.

Setting

The procedure is performed in a hospital’s operating room, often in a specialized thoracic surgery unit.

Personnel

• Surgeon (specializing in thoracic surgery)
• Anesthesiologist
• Surgical nurses
• Respiratory therapist (post-operative care)

Risks and Complications

• Common risks: Infection, bleeding, reaction to anesthesia.
• Rare risks: Tracheal anastomosis failure, recurrent laryngeal nerve injury (affecting vocal cords), prolonged need for mechanical ventilation.
• Management: Close monitoring, antibiotics, additional surgeries if needed.

Benefits

• Expected benefits: Improved breathing, reduction in respiratory symptoms, and enhanced quality of life.
• Realization timeframe: Benefits typically noticed within a few weeks as the trachea heals and normal airflow is restored.

Recovery

• Post-procedure care: Pain management, antibiotics to prevent infection, and monitoring in the ICU.
• Recovery time: Initial recovery in the hospital for 1-2 weeks, with full recovery over several months. Restrictions on physical activity and follow-up bronchoscopy to assess healing.

Alternatives

• Other options: Endoscopic balloon dilation, tracheal stenting, non-surgical management with medications.
• Pros and cons: Less invasive options may provide temporary relief but might not be as effective for severe cases. Non-surgical methods often have a higher chance of recurrence.

Patient Experience

• During the procedure: The patient will be under general anesthesia and will not feel anything.
• After the procedure: Discomfort around the incision site and throat, managed with pain medications. Hospital stay for monitoring, with gradual return to normal activities guided by the surgical team.