Tracheopexy

Tracheopexy is a surgical procedure to stabilize the trachea by anchoring it to surrounding mediastinal structures to prevent dynamic tracheal collapse, as seen in tracheomalacia or bronchomalacia. By limiting excessive tracheal movement during breathing, the operation aims to improve airway patency and facilitate weaning from ventilatory support in selected patients.

Indications: The procedure is typically reserved for severe congenital tracheomalacia or bronchomalacia that fails medical therapy, especially in infants with other congenital anomalies (for example esophageal atresia) or after prolonged ventilation with persistent airway obstruction.

Techniques: Several approaches exist, including anterior tracheopexy and posterior tracheopexy, performed via thoracotomy or minimally invasive thoracoscopic methods. In some cases, tracheopexy is combined with aortopexy to alleviate external vascular compression of the trachea.

Outcomes: In experienced centers, tracheopexy has been associated with improved airway patency, fewer respiratory events, and earlier extubation in many patients. Long-term results depend on the severity of the condition and associated anomalies, with some patients requiring additional procedures.

Risks and considerations: Potential complications include bleeding, infection, injury to the recurrent laryngeal nerves, and recurrence of airway collapse, necessitating further surgery. The procedure is generally considered only after careful multidisciplinary evaluation and is not suitable for all patients with airway collapse. See also aortopexy, tracheostomy, tracheomalacia.