[Tracheal and laryngeal resection and anastomosis in the treatment of chronic obstruction].

Prolonged intubation and inadequate management of acute injuries of the larynx are the most common causes of increasing number of tracheal and laryngeal stenosis. Different conservative procedures are not sufficient in a large number of severe stenosis of the laryngotracheal tree. The author presents a single-stage procedure of surgical resection of the trachea for 3-4 cm with anastomosis for managing severe circular stenosis of different etiologies. Out of five successfully operated patients stenosis resulted from prolonged intubation in two cases, and from malignant tumor, benign tumor and inflammation of undetermined etiology in the three respective cases. Several years postoperatively, patency of the trachea at the site of the anastomosis remains normal. Stenosis of the subglottis or the initial part of the trachea at the site of anastomosis remains normal. Stenosis of the subglottis of the initial part of the trachea were managed by resections of the cricoid or half of the larynx with reconstruction of the new larynx in the same procedure by an open and elevated trachea. The reconstruction was initially evaluated experimentally and afterwards applied clinically as laryngotracheoplasty-Successful decannulation was performed in six patients subjected to this type of surgery, and normal breathing, speech and swallowing functions were maintained. One patient died after the operation owing to hepatic coma induced by unrecognized liver metastases. The importance of preserving blood vessels for prevention postoperative necrosis and dehiscence of the anastomosis has been pointed out. In both types of reconstruction anastomoses were performed by subucosal sutures making in possible to heal with no associated granuloma and restenosis, avoiding complicated endoscopic removal of the sutures and granulomas in the postoperative course. The new method of cricoid nad laryngeal reconstruction by a trachea provides a vide neolaryngeal lumen, successful decannulation and preservation of all laryngeal functions.