Silicone stents in the management of benign tracheobronchial stenoses. Tolerance and early results in 63 patients.

STUDY OBJECTIVE

To assess tolerance and early results of Dumon silicone stents inserted in patients with nonneoplastic airway obstruction.

DESIGN

Tracheobronchial stenting for palliative or curative restoration of airway narrowing has been evaluated in a retrospective study.

SETTING

Tertiary-referral teaching hospital.

PATIENTS

Between May 1991 and September 1994, 64 patients with a mean age of 52 years had endobronchial silicone stent insertion for benign tracheal stenosis (82% secondary to intubation or tracheostomy injury). Lesions were pure fibrous stenosis in 25 patients and fibroinflammatory stenosis in 38. Prostheses were used for temporary stenting of the airway during 18 months in 48 patients in whom cure was expected and as a procedure for palliation in the remaining 15 patients.

INTERVENTIONS

In all cases, the Dumon tracheobronchial stent was implanted with the rigid bronchoscope under general anesthesia.

RESULTS

Five patients died (four from unrelated causes); one was due to hypersecretion and airway obstruction at the time of an emergency tracheostomy 20 days after stent insertion. Complications included migration of prostheses in 11 (17.5%) patients, granuloma formation in 4 (6.3%) patients, and airway obstruction due to heavy secretion in 4 (6.3%). In 48 patients who received silicone stents with curative expectations, removal of the device was accomplished in 21 patients. Therapy proved successful in 17 patients with a mean follow-up of 259+/- 173 days and stenosis recurred in 4. In 16 patients, stents still remain for a mean period of 364+/-119 days. In the series of 15 patients in whom silicon stents were implanted for palliation, prostheses were placed permanently in 11 with a mean follow-up of 486+/-260 days. In the remaining four patients with tracheostomy, silicone stents were used after inability to expand the upper limb of the T-tube (two patients) or placed above the tracheostomy stoma to maintain laryngotracheal patency and preserve phonation when a T-tube was poorly tolerated (two patients).

CONCLUSIONS

Silicone tracheobronchial stents are effective in the maintenance of airway patency and are associated with good tolerance and infrequent complications that are rarely life-threatening.