Skip to main content

End-to-end anastomosis in the management of laryngotracheal defects

  • E D Gozen (a1), M Yener (a1), Z B Erdur (a1) and E Karaman (a1)
Abstract Objective:

To present clinical experience and surgical outcomes of end-to-end anastomosis in the management of laryngotracheal stenosis and tracheal defects following invasive thyroid malignancy resection.


A retrospective analysis was performed of 14 patients with laryngotracheal stenosis and tracheal invasive thyroid malignancy. All patients underwent tracheal or cricotracheal resection and primary end-to-end anastomosis.


Length of stenosis was 1.7–4 cm. Stenosis was classified as Myer and Cotton grade II in 4 patients, grade III in 6 and grade IV in 2. Surgical procedures included tracheotracheal end-to-end anastomosis (n = 4), cricotracheal anastomosis (n = 2) and thyrotracheal anastomosis (n = 6). Patients with invasive thyroid malignancy underwent segmental resection of the involved segment with tumour-free margins, and tracheal or cricotracheal end-to-end anastomosis. Successful decannulation was achieved in 13 patients (93 per cent). Post-operative complications were: wound infection (n = 1), subcutaneous emphysema (n = 1), temporary unilateral vocal fold palsy (n = 1), granulation tissue development (n = 1), and restenosis (n = 2).


End-to-end anastomosis can be used safely and successfully in the management of advanced laryngotracheal stenosis and wide laryngotracheal defects. Greater success can be achieved using previously described surgical rules and laryngotracheal release manoeuvres.

Corresponding author
Address for correspondence: Dr Emin Karaman, İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi, KBB ABD, Cerrahpasa, Fatih, 34098, İstanbul, Turkey E-mail:
Hide All
1 Ramdev S, Ghosh P, Mukhopadhyaya S. Radiological evaluation of chronic laryngotracheal stenosis. Indian J Otolaryngol Head Neck Surg 2005;57:108–9
2 Stauffer JL, Olson DE, Petty TL. Complications and consequences of endotracheal intubation and tracheostomy: a prospective study in 150 critically ill adult patients. Am J Med 1981;70:6576
3 Pearson FG, Andrews MJ. Detection and management of tracheal stenosis following cuffed tube tracheostomy. Ann Thorac Surg 1971;12:359–74
4 Grillo HC, Donahue DM, Mathisen DJ, Wain JC, Wright CD. Postintubation tracheal stenosis: treatment and results. J Thorac Cardiovasc Surg 1995;109:486–92
5 Myer CM, O'Connor DM, Cotton RT. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol 1994;103:319–23
6 Pearson FG, Cooper JD, Nelems JM, Van Nostrand AW. Primary tracheal anastomosis after resection of the cricoid cartilage with preservation of recurrent laryngeal nerves. J Thorac Cardiovasc Surg 1975;70:806–16
7 Grillo HC. Primary reconstruction of airway after resection of subglottic laryngeal and upper tracheal stenosis. Ann Thorac Surg 1982;33:318
8 Wynn R, Har-El G, Lim JW. Tracheal resection with end-to-end anastomosis for benign tracheal stenosis. Ann Otol Rhinol Laryngol 2004;113:613–17
9 Grillo HC. Management of nonneoplastic diseases of the trachea. In: Shields TW, LoCicero J 3rd, Ponn RB, eds. General Thoracic Surgery, 5th edn. Philadelphia: Lippincott Williams and Wilkins, 2000;885–97
10 Liu L, Wu W, Ma Y, Liu Y, Wang Y, Oghagbon EK et al. Laryngotracheal resection and reconstruction for subglottic tracheal stenosis--our experience of 32 cases. Clin Otolaryngol 2015;40:143–7
11 Pookamala S, Kumar R, Thakar A, Venkata Karthikeyan C, Bhalla AS, Deka RC. Laryngotracheal stenosis: clinical profile, surgical management and outcome. Indian J Otolaryngol Head Neck Surg 2014;66:198202
12 Sarper A, Ayten A, Eser I, Ozbudak O, Demircan A. Tracheal stenosis after tracheostomy or intubation: review with special regard to cause and management. Tex Heart Inst J 2005;32:154–8
13 Zias N, Chroneou A, Tabba MK, Gonzalez AV, Gray AW, Lamb CR et al. Post tracheostomy and post intubation tracheal stenosis: report of 31 cases and review of the literature. BMC Pulm Med 2008;8:18
14 Sharpe DA, Dixon K, Moghissi K. Endoscopic laser treatment for tracheal obstruction. Eur J Cardiothorac Surg 1996;10:722–6
15 Marques P, Leal L, Spratley J, Cardoso E, Santos M. Tracheal resection with primary anastomosis: 10 years experience. Am J Otolaryngol 2009;30:415–18
16 Rubikas R, Matukaitytė I, Jelisiejevas JJ, Račkauskas M. Surgical treatment of non-malignant laryngotracheal stenosis. Eur Arch Otorhinolaryngol 2014;271:2481–7
17 Krajc T, Janik M, Benej R, Lucenic M, Majer I, Demian J et al. Urgent segmental resection as the primary strategy in management of benign tracheal stenosis. A single center experience in 164 consecutive cases. Interact Cardiovasc Thorac Surg 2009;9:983–9
18 Rosen FS, Pou AM, Buford WL. Tracheal resection with primary anastomosis in cadavers: the effects of releasing maneuvers and length of tracheal resection on tension. Ann Otol Rhinol Laryngol 2003;112:869–76
19 Grillo HC, Dignan EF, Miura T. Extensive resection and reconstruction of mediastinal trachea without prosthesis or graft: an anatomical study in man. J Thorac Cardiovasc Surg 1964;48:741–9
20 Montgomery WW. Suprahyoid release for tracheal anastomosis. Arch Otolaryngol 1974;99:255–60
21 Dedo HH, Fishman NH. Laryngeal release and sleeve resection for tracheal stenosis. Ann Otol Rhinol Laryngol 1969;78:285–96
22 Maddaus MA, Toth JL, Gullane PJ, Pearson FG. Subglottic tracheal resection and synchronous laryngeal reconstruction. J Thorac Cardiovasc Surg 1992;104:1443–50
23 George M, Lang F, Pashe P, Monier P. Surgical management of laryngotracheal stenosis in adults. Eur Arch Otorhinolaryngol 2005;262:609–15
24 Negm H, Mosleh M, Fathy H. Circumferential tracheal resection with primary anastomosis for post-intubation tracheal stenosis: study of 24 cases. Eur Arch Otorhinolaryngol 2013;270:2709–17
25 Couraud L, Jougon JB, Velly JF. Surgical treatment of nontumoral stenoses of the upper airway. Ann Thorac Surg 1995;60:250–6
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 5
Total number of PDF views: 70 *
Loading metrics...

Abstract views

Total abstract views: 453 *
Loading metrics...

* Views captured on Cambridge Core between 13th March 2017 - 21st January 2018. This data will be updated every 24 hours.