Laryngotracheal resection can be performed safely without a guardian Chin stitch—a single-centre experience including 165 consecutive patients

Abstract OBJECTIVES A tension-free anastomosis is crucial to minimize the risk of airway complications after laryngotracheal surgery. The ‘guardian’ chin stitch placed prevent hyperextension neck in early postoperative period. This manoeuvre was introduced tracheal surgery and now routinely performed by many surgeons. However, evidence for or against sparse. METHODS We a retrospective analysis all adult patients receiving (laryngo-)tracheal resection at our department from October 2011 December 2019. According institutional standard, none received stitch. Instead, head cradle used obtain anteflexion during first 3 days were instructed avoid hospital stay. outcome rate anastomotic analysed. RESULTS total 165 consecutive included this study. Median age 53 years (18–80). Seventy-four resection, 24 cricotracheal 52 an extended including dorsal mucosectomy 15 single-stage reconstruction. median length 25 mm (range 10–55 mm). One hundred sixty-two out (98.2%) had unremarkable course. patient (0.6%) partial rupture traumatic reintubation, which required revision re-anastomosis. Two (1.2%) previous radiation therapy (>60 Gy) developed necrosis anastomosis, resulting prolonged airleak fistulation. At follow-up, bronchoscopy months surgery, 92.7% (127/137) proper 6.6% (9/137) minor granuloma formations site treated successfully endoscopic removal. dilatation restenosis (0.7%). CONCLUSIONS After sufficient mobilization central airways, supported excessive tension dehiscence. Considering severe neurological associated with stitch, routine use should not be recommended.