Posterior Tracheopexy For Severe Tracheomalacia

This is Todd Ponsky with the Journal of Pediatric Surgery, and here's your two-minute review. Today, we have Dr. Ian Glenn, my research fellow here at Akron Children's Hospital. Today is his last day before he goes back to general surgery residency at the Cleveland Clinic. Ian, what do you have for us today? So, thanks Todd. This paper is about patients who have tracheomalacia, and specifically it's called Posterior Tracheopexy for Severe Tracheomalacia. The first author is Hester Sheha and the last author is Russell Jennings. So specifically, they looked at 98 patients who had severe tracheomalacia with what they called posterior membranous intrusion. So, all these patients got bronchoscopy, and they saw that uh the trachea tended to collapse inward from the posterior aspect. So they made a point of distinguishing between patients who had anterior compression and posterior compression. Anterior compression being from the aortic arch, posterior compression being collapse. Um, so they were specifically looking at these posterior patients and this posterior tracheopexy where they take pledgetted sutures and so the trachea to the anterior longitudinal ligament of the spine. Your posterior wall of the trachea. Correct. Okay. So they looked at 98 patients, 88% of whom had esophageal atresia with or without TEF, not surprisingly. And they followed these patients anywhere from one week to 36 months. And they saw that um for clinical symptoms they improved pretty much across the board. So cough, barking cough, noisy breathing, infections, all those things improved. And then the patients also improved on bronchoscopic evaluation. The only thing that didn't improve statistically was exercise tolerance, but they said they showed a trend towards improvement. So, I think the important thing this paper showed us was that tracheomalacia isn't just one homogeneous disease. They emphasized the importance of systematic bronchoscopic evaluation and realizing that some patients are going to benefit from posterior tracheopexy, some patients are going to benefit from aortopexy or anterior and some patients are going to need both. So I think 20% of the patients almost in this study required both. Um so there's definitely a need for some standardization. This is really cool for me. I'd never heard of a posterior tracheopexy. It certainly opens up the door for new opportunity of this new procedure. I'd love to learn more about how to do it. I don't know if they have images, if not uh. They go a little bit into the technique but I agree. Some images would be really nice. Great. All right. well, thank you. It's been great having you as a fellow. Thank you.