Clinical Report: Surgical Management of Tracheal Stenosis During Covid-19 Pandemic

Overview

This single-center study analyzed surgical outcomes of tracheal resection and primary anastomosis in patients with benign tracheal stenosis during the Covid-19 pandemic. It compared post-Covid-19 patients requiring prolonged invasive mechanical ventilation with non-Covid-19 patients, highlighting increased incidence and management challenges in the former group.

Background

Tracheal stenosis is a serious condition often caused by prolonged invasive mechanical ventilation, leading to ischemic injury and scarring of the tracheal mucosa. The Covid-19 pandemic increased the number of patients requiring prolonged ventilation, thereby raising the incidence of post-intubation tracheal stenosis. Clinical symptoms include dyspnea, wheezing, and stridor, with diagnosis confirmed by bronchoscopy and CT imaging. Surgical resection with primary end-to-end anastomosis remains a key treatment after failure of conservative endoscopic approaches.

Data Highlights

The study retrospectively collected clinical, demographic, intra- and postoperative data from May 2020 to October 2021 on patients undergoing surgery for benign tracheal stenosis. All post-Covid-19 patients were confirmed SARS-CoV2 negative at surgery and surgery was preferably delayed at least 2 months post-ICU discharge when possible. Surgical technique involved intraoperative bronchoscopy, distal and proximal resection of stenotic trachea, and primary anastomosis with absorbable sutures. Postoperative management included early extubation and bronchoscopy on days 3 and 7 to monitor anastomosis patency.

Key Findings

• Prolonged invasive mechanical ventilation (>14 days) is the main cause of acquired tracheal stenosis, with Covid-19 patients requiring longer ventilatory support and higher tracheostomy rates.
• Up to 5% of mechanically ventilated Covid-19 patients develop chronic upper airway symptoms or tracheal stenosis.
• The center observed a marked increase in post-IMV tracheal stenosis cases during the pandemic, many requiring surgical intervention after failed endoscopic treatment.
• Surgical resection and primary end-to-end anastomosis were performed safely with intraoperative bronchoscopy guidance and careful postoperative monitoring.
• No precise timing was set between Covid-19 infection and surgery, but a minimum 2-month delay was preferred to allow recovery from acute illness.
• Postoperative management avoided chronic steroids, using short-term high-dose corticosteroids only when necessary.

Clinical Implications

Clinicians should be vigilant for tracheal stenosis in patients recovering from prolonged mechanical ventilation, especially post-Covid-19. Multidisciplinary preoperative assessment including bronchoscopy and CT imaging is essential for surgical planning. Early surgical intervention with resection and primary anastomosis can be effective after failure of conservative treatments, with careful postoperative airway monitoring to ensure anastomotic integrity.

Conclusion

The Covid-19 pandemic has increased the incidence of tracheal stenosis due to prolonged ventilation, necessitating surgical management in many cases. This study supports the safety and efficacy of surgical resection and primary anastomosis in post-Covid-19 and non-Covid-19 patients with benign tracheal stenosis.

References

1. Richards-Belle et al. 2020 -- Covid-19 ICU ventilatory support duration
2. General literature references [1-10] on tracheal stenosis and surgical techniques