# Posterior Tracheopexy For Severe Tracheomalacia — GCMD Library Dr. Ian Glenn and Dr. Todd Ponskygive a two minute review of "posterior tracheopexy for severe tracheomalacia," and article published in the Journal of Pediatric Surgery.Dr. Hester Shieh and colleagues performed posterior tracheopexy on patients who had significant posterior intrusion of the trachea, with significant improvement in clinical symptoms.Article:http://dx.doi.org/10.1016/j.jpedsurg.2017.03.018?externalLink=1 Type: video · 2 min · posted 2018-09-16 Canonical: https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375 ## Chapters - [0:00](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=0) Introduction - [0:15](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=15) Study Overview and Technique - [1:05](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=65) Results and Clinical Implications - [1:58](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=118) Closing Remarks ## Statements - "The paper studied 98 patients who had severe tracheomalacia with posterior membranous intrusion" — Ian Glenn (clinical) [0:28](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=28) - "All patients received bronchoscopy showing the trachea tended to collapse inward from the posterior aspect" — Ian Glenn (clinical) [0:35](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=35) - "Anterior compression is from the aortic arch, while posterior compression is from collapse" — Ian Glenn (clinical) [0:44](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=44) - "Posterior tracheopexy involves taking pledgeted sutures and sewing the posterior wall of the trachea to the anterior longitudinal ligament of the spine" — Ian Glenn (clinical) [0:54](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=54) - "88% of the 98 patients had esophageal atresia with or without TEF" — Ian Glenn (epidemiological) [1:05](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=65) - "Patients were followed anywhere from 1 week to 36 months" — Ian Glenn (clinical) [1:05](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=65) - "Clinical symptoms including cough, barking cough, noisy breathing, and infections improved across the board" — Ian Glenn (clinical) [1:15](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=75) - "Patients improved on bronchoscopic evaluation" — Ian Glenn (clinical) [1:25](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=85) - "Exercise tolerance did not improve statistically but showed a trend towards improvement" — Ian Glenn (clinical) [1:30](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=90) - "Tracheomalacia is not one homogeneous disease" — Ian Glenn (clinical) [1:35](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=95) - "Some patients benefit from posterior tracheopexy, some from aortopexy or anterior approach, and some need both" — Ian Glenn (clinical) [1:45](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=105) - "Almost 20% of patients in the study required both posterior and anterior procedures" — Ian Glenn (clinical) [1:54](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=114) ## Transcript This is Todd Ponsky with the Journal of Pediatric Surgery, and here's your two-minute review. Today we have Doctor 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 She 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 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. So they were specifically looking at these posterior patients and this posterior tracheopexy where they take pledgeted sutures and sew the trachea to the anterior longitudinal ligament of the spine, the posterior wall of the trachea, correct. OK. So they looked at 98 patients, 88% of whom had esophageal resia with or without TEF, not surprisingly, and they followed these patients anywhere from 1 week to 36 months. And they saw that 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 the study required both. Um, so, there's definitely a need for some standardization. This is really cool for me. I've never heard of a posterior tracheopexy. It certainly opens up the door for new opportunity of this new procedure. That's. 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. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai