What is a resection
(resection and reconstruction)
and how is it done?
A tracheal resection is a complex surgery that involves removing a scarred portion of the trachea and reconnecting the healthy ends. You may hear it also called Cricotracheal resection (CTR), Laryngeal Tracheal Resection (LTR) or Tracheal resection and reanastamosis. All are slightly different but with similarities. For example, when the scarred portion is particularly long, a stent or piece of rib is inserted into the neck to replace the lost cartilage and prevent the neck from collapsing.
What is the success rate of this surgery?
Published articles suggest an 80-95% success rate. On average, a resection will last around 10 years. As with all averages, some last less time, others longer.
Self-help tracheal stenosis's note: At the ENT Clinic in Stuttgart, they speak of a success rate of 90-95% for cricotracheal resection, but the risk profile should not be underestimated.
Can previous treatments 'mess up' your candidacy for resection?
Most skilled doctors will still be able to conduct a resection no matter how many dilations you have had. There may be other reasons you are rejected for a resection, however.
What exactly are the risks?
The main risk is restenosis. Next is damage to the nerves of the vocal cords. There is about 1% chance of bleeding or infection. Around 5% of patients with a very experienced surgeon will go on to re-stenose within the immediate 3 years.
Most patients will have some permanent change in voice (often deeper) due to changes in laryngeal elevation (needed for a good vocal range, especially in singers). Some may not be able to project their voice or speak loudly.
Self-help tracheal stenosis note: The more experienced the clinic or the operating doctors are, the higher the success rate of the procedure.
How bad is the pain? How long are you on pain meds?
Talk to your doctor ahead of time about pain relief and muscle relaxers. Some say the position the chin stitch puts you in (if used) is the greatest pain. The hospital will manage your pain in the best way for you. Some report experiencing a pain level of maybe 7 out of 10 day one and two, 5 out of 10 day three and then maybe a 2 out of 10 for the final few days.
What is a chin stitch?
The chin stitch can be used to help keep the head in position in the case of long segment stenosis removal, but the trend has generally to be to move away from this technique. If your surgeon plans to use a chin stitch (sometimes called a ‘Grillo stitch’ after the first doctor who used this technique) please ensure you are comfortable with their expertise and their reasons for using it.
Doctors who have been performing many resections with the chin stitch for many years are confident in the safety of this technique. If you are certain with the level of experience of your surgeon, then you should be safe with this technique. These days, it is more common to have a c-collar for a few weeks and keep the neck flexed as much as possible.
Self-help tracheal stenosis's note: There are still clinics in Germany where the chin stitch is used. Experienced doctors such as Dr. Sittel and Dr. Kölmel in Stuttgart in Germany do not use chin-chest sutures.
Do you have difficulty swallowing after surgery?
How long before you can start to eat and drink? Most patients are on a feeding tube for up to 5 days before being placed on a soft diet. You will likely be given medicine via IV to calm your stomach.
How long after surgery before they have you up and around?
You are encouraged to move around and are likely to be walking within the first two days.
I saw mention of a drain, what is that, where is it placed and for how long?
It comes out from your chest or beside your neck incision and it is in 3 or 4 days, it is more unattractive than painful.
Do you need to have an feeding tube and catheter?
If so, for how long? You are likely to be given catheter. If you can walk, they will let you take it out.
Are you on antibiotics or any other type of meds following surgery?
If so, how long? Some receive steroids to keep swelling down as a daily injection at the hospital and then taken orally on a tapering dose for 2 weeks. You may also be given acid reflux medication as a precaution.
Are you required to be on voice rest after surgery?
If so, how long? There are varying experiences – some are asked to speak right away, while others are put on voice rest for several weeks.
How long does it take for your voice to get as good as it will get?
This is not known for sure – some patients require voice coaching to strengthen their vocals and return to near previous levels. Others will always have a weaker or raspy voice.
What is the recovery time and what can I do during this period?
Generally a minimum of 6 weeks off work, and return to work depends on each individual, as everyone feels and recuperates differently. Many patients are told they cannot drive for 8 weeks.
How bad is the scar?
The scar is about 7.5cm (3 inches) in length.
Can also have a small 1 cm (half an inch) scar where the drain is located.