Laser tracheobronchoplasty: a novel technique for the treatment of symptomatic tracheobronchomalacia

Abstract

The management of tracheobronchomalacia is a very challenging problem with few treatment options. This study aims to evaluate the outcomes of a novel surgical treatment for membranous tracheobronchomalacia. A consecutive series of patients with tracheobronchomalacia were treated with two to three holmium laser scarring surgeries of the hyperdynamic tracheal and bronchial walls for the purpose of stiffening them through fibrosis. Patients filled out a Dyspnea Index questionnaire before and after treatment. Ten patients were treated for their tracheobronchomalacia with a mean age of 54 years. Symptoms included severe dyspnea, dry cough, recurrent pulmonary infections, and respiratory failure. Fifty percent of patients presented with wheezing refractory to traditional treatment. Tracheobronchomalacia was associated with gastroesophageal reflux disease (n = 8), obstructive sleep apnea (n = 5), and tracheal stenosis (n = 3). Only 50 % of patients presented with morbid obesity. All cases showed significant improvement of their respiratory symptoms with a mean postoperative difference of 22.3 out of a maximum impairment score of 40 (P < 0.01) on the Dyspnea Index. The mean number of procedures was 2.3 per patient with the average laser energy delivered per procedure of 1600 J. Laser tracheobronchoplasty is a safe, easy to adopt, and effective technique for the treatment of membranous tracheobronchomalacia. It presents a simple alternative to the commonly used procedures like endoluminal stenting and open tracheobronchoplasty.