What is a trachea?
A trachea, also called a windpipe, is a tube about 4 inches long and less than an inch in diameter in most people. This tube connects the larynx (voice box) to the lungs. The trachea begins just under the voice box (larynx) and runs down behind the breastbone (sternum). The trachea then divides into two smaller tubes called the bronchi, which is then divided into the lungs. The trachea widens and lengthens slightly with each breath in, returning to its resting size with each breath out.
What is tracheal resection?
Tracheal resection is a surgical procedure of the windpipe. The procedure involves removing a part of the windpipe and stitching back the remaining part. Tracheal resection is most commonly performed in cases of cancers involving the windpipe or secondary to injury or sometimes after an incision in the windpipe made to relieve an obstruction to breathing (tracheostomy). Patients present with signs of airway obstruction particularly when lying flat.
Up to 50% of the tracheal length can be removed by a simple surgery, and the remaining ends can be connected. Only occasionally, an artificial reconstruction of trachea may be required.
When does an individual require tracheal resection?
Tracheal resection is performed when there is significant narrowing in the windpipe. Narrowing of the windpipe can cause life-threatening conditions. Below are some common causes for tracheal resection:
- Windpipe deformities by birth
- Tumors, lesions, and cancers (aggressive and nonaggressive)
- Windpipe scarring
- Injury to the windpipe
- Severe breathing difficulties
- Chest infections
- Swallowing difficulties
How long does tracheal resection take?
Tracheal resection is a major surgery and usually takes approximately eight hours. The procedure is usually performed under general anesthesia or intravenous sedation.
- After administering anesthesia, the surgeon monitors the patient’s oxygen and heart rate throughout the procedure.
- The surgeon makes an incision in the middle of the chest, which exposes the heart, large blood vessels entering and leaving the heart, and the windpipe, which is located behind these.
- Once the surgeon locates the windpipe and identifies the narrow section, they will connect a bypass machine, which will take over the function of the heart and lungs. The surgeon can then cut the windpipe, removing its narrow section. The surgeon will stitch back together the cut ends of the windpipe.
- Usually, the surgeon uses a flexible tube called bronchoscope to look inside the windpipe, which ensures the repair has been successful.
- Once ready, the surgeon disconnects the bypass machine and withdraws the bronchoscope.
- The surgeon closes the chest with stitches and inserts drain tubes to drain away any blood and allow antiseptic fluid to flow around the site of surgery, reducing the risk of infection.
What is the outcome after tracheal resection?
The vast majorities of patients who undergo this procedure do very well and require very little ongoing care in the long term. Tracheal resection allows patients to lead a normal life without any breathing or swallowing difficulties.
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After the procedure, the patient may be on several tubes and have wires connected to them. These are necessary to keep them hydrated, comfortable, pain free, and to avoid any complications. Antibiotics, painkillers and anti-reflux medicines are given to the patient to avoid any infection and pain.
The tubes and wires may be removed in the next few days as the healing process starts. The breathing tube is often removed one or two days after the surgery. Sometimes, it may take longer to remove the tube, depending on how the patient is coping.
It is often necessary to repeat bronchoscopy and bronchography before and after the breathing tube has been removed to ensure there is no floppiness or narrowing of the airway. Once the tube has been removed, a speech and language assessment will be performed to ensure that the patient can swallow normally and that it is safe for them to start feeding by mouth.
Once this happens, and any other outstanding issues are addressed, the patient may be discharged home. Antibiotics are continued to prevent any chest infections.
What are the risks involved in tracheal resection?
There are risks associated with any surgical procedure, and these are usually explained to the patient and their family. The risks include the following:
- Infection and bleeding after the procedure
- Damage of nearby organs during the procedure
- Blood clots
- Leak from the joint of the windpipe
- Decrease in oxygen levels that may be sometimes be life threatening
- Scar formation from the operated site
- Narrowing of the windpipe
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