What is Tracheal Resection Surgery?
Tracheal Resection surgery is performed to remove a narrowed portion of a patient’s trachea or windpipe.
This surgery may be performed for a patient with tracheal stenosis, which is often because of a scar in the airway.Scars in the airway may occur as a result of trauma, as a result of an endotracheal tube or breathing tube, or may form for unknown reasons. Tracheal resection may also be performed if a cancer originates from or invades the airway.
During a tracheal resection, your surgeon removes the constricted section of your windpipe and rejoins the ends. This is usually a very successful treatment, with excellent long-term results.
PRE-OPERATIVE TESTS
A number of tests are often necessary before laryngotracheal reconstruction surgery. The goal of each test is to help evaluate medical conditions that may cause problems with the airway or affect the surgical plan and to prepare for individual follow-up care, including:
Endoscopic examination provides a direct view of the airway and allows accurate assessment of the location, length and severity of the airway narrowing. Because of the frequent association of acid reflux, it may be combined with upper gastrointestinal endoscopy to view the esophagus and stomach.
Pulmonary function tests determine whether your lungs can handle certain airway reconstruction procedures.
CT scan and MRI tests may be used to further visualize the laryngotracheal anatomy and the lungs.
Swallowing difficulty (dysphagia) evaluations record the swallowing process as you eat or drink.
Voice evaluation helps find the cause of vocal problems and helps plan effective treatment.
PH/impedance probe studies help determine whether acid from the stomach is backing up into the esophagus and airway.
Sleep studies (polysomnograms) look for disruptions in your sleep pattern caused by the airway.
THE PROCEDURE
The surgical approach for this procedure may be addressed using the Traditional Open Procedure, or a Minimally Invasive approach.
Traditional Open Approach
Once the windpipe has been located and the narrow section is identified, a bypass machine will be connected, which takes over the function of the heart and lungs.
The surgery can then be performed to cut the windpipe, removing the narrow section of windpipe.
Often, a bronchoscopy is undertaken at this point to look inside the windpipe and ensure the repair has been successful. Once ready, the bypass machine is disconnected and the heart and lungs resume their normal function.
The chest is closed with stitches and drain tubes are inserted to drain away any blood and allow antiseptic fluid to flow around the site of surgery, reducing the risk of infection.
Minimally Invasive Approach
MIS Tracheal Resection surgery is performed with a patient asleep through a cut on the neck. The narrowed portion of the trachea is identified and removed.
The upper and lower normal portions of the trachea are then reattached to one another with stitches.
To release tension on the area of anastamosis (or joining segment) maneuvers such as tracheal release, or suprahyoid release may be performed. This allows for increased manipulation of the two ends to provide for closure of the defect.
You are then transferred to the Cardiac Intensive Care Unit (CICU) with a breathing tube going into the windpipe connected to a ventilator machine that controls your breathing.
PREPARATION FOR SURGERY
Before traveling to Cyprus, as part of your surgery preparation we require detailed medical information in the form of a medical questionnaire, ECG, Cardiac and Pulmonary tests and blood work. In some cases an Angiogram is required.
Although not all the tests may be required for each patient, they usually include:
All of this information will allow the doctors that we work with to determine your eligibility for the procedure. Your surgeon will give you specific instructions about any dietary changes or activity restrictions you should follow before surgery.
Tell your surgeon what medications you are taking, especially aspirin or an anticoagulant ("blood thinner"). Your surgeon will tell you if you should stop taking them. Also bring a complete list of your current medications (including over-the-counter drugs, vitamins and herbal supplements), allergies, your medical records and any health insurance information.
If you smoke, stop immediately to improve your blood flow and breathing.
If you develop a cold, fever or sore throat within a few days of your surgery, or have other questions or concerns, contact our offices immediately.
Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.
Upon arriving in Cyprus, as part of the pre-surgery tests done at our partner hospitals you will again receive chest X-rays, blood tests, an electrocardiogram and any other pre operative tests your surgeon feels necessary.
Your surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will discuss your procedure and answer any questions.
Getting Your House Ready For Surgery
It is also important to get your house ready for after you come home from the hospital. At first it will be harder for you to move around, so arrange your furniture and household items ahead of time to make it easier for you during your rehabilitation.
Preparation for the hospital
Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:
Clothing
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:
Day Before Surgery
Your surgical nurse will provide you with these instructions the night before surgery:
Morning Of Surgery
On the day of your surgery, your designated Salus Patient Concierge along with a nurse may talk with you and your loved ones. They shall tell you what to expect. You will most likely feel a little nervous before surgery, so the SALUS team and the hospital staff will do all they can to answer your questions and help you relax.
Make sure all your medicines in their original containers with you to the hospital.
You will meet with the anesthesiologist who will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery.
You should leave jewelry, watches, money and other valuables with the person who accompanies you or with our staff member who will place them in our safe.
Proceed with your routine morning care:
RECOVERY AFTER SURGERY
After surgery, the patient is moved to the Intensive Care Unit where family members can visit the periodically for one or two days.
Immediately after the procedure patients are awakened from the general anesthetic and allowed to breathe on their own.
Patients with a tracheotomy tube are able to speak and eat. An exception is patients who require the ventilator to breathe.
A breathing tube will be in place through the nose after the surgery. The breathing tube holds the airway and graft in place while it heals so it does not shrink back down. Your surgeon will decide how long the breathing tube needs to stay in place; however, it is often removed one or two days after surgery. Sometimes it may take longer to remove the tube, all depending on how your recovery is.
It is often necessary to repeat a bronchosocpy 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, you will be transferred to your room.
On the evening after the procedure there will be many tubes and wires connected to you however, these are necessary in order to keep you well hydrated, comfortable, pain free and to let the staff know at the earliest opportunity if there are any problems.
Drainage tubes are left in the chest to drain any excess air or fluid from the chest after surgery. These are removed once the air and fluid leakage stops.
Medications such as antibiotics to reduce infection and anti-reflux medicines are started.
The tubes and wires decrease in number over the next few days, as the healing process takes place and your child’s condition becomes less critical.
Hospital Discharge and Home Instructions
Your diet is slowly increased from ice chips to liquids to solid foods as your intestines start functioning.
Physical therapy is reinstituted early during the recovery phase during the hospitalization.
Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom, managing steps at home and getting in and out of a car.
You will be able to leave the hospital when you are:
You will remain hospitalized for about 8-10 days while your recovery is monitored and your vital signs are checked frequently – depending on the approach your surgeon has chosen.
A speech and language assessment will be carried out to ensure that your swallowing function is normal and that it is safe to start feeding by mouth.
Once this happens, and any other outstanding issues are addressed, you be discharged home.
Antibiotics are continued three times a week to prevent against chest infections.
LIFE AFTER SURGERY
These guidelines give you an overview of what you may expect as part of your care after you leave the hospital. Be sure to follow your doctor’s discharge instructions if they are different from what is listed here.
A follow-up bronchoscopy and bronchography will normally be undertaken a few months after the procedure, providing there are no problems. This may have to be carried out earlier if needed.
Based on the results of this investigation, further follow-up will be decided. Sometimes it is necessary to stretch the inside of the windpipe with a balloon if there is any residual narrowing, and occasionally this may have to be repeated several times (this is referred to as balloon dilatation). Your surgeon will advise you regarding your post operative Follow-up.
Patients are often advised to eat less fat and cholesterol and to walk or do other physical activity to help regain strength.
Doctors also often recommend following a home routine of increasing activity- doing light housework, going out, visiting friends, climbing stairs. The goal is to return to a normal, active lifestyle.
Most people with sedentary office jobs can return to work in four to six weeks. Those with physically demanding jobs will have to wait longer. In some cases they may have to find other employment.
Lifting and Reaching
If your surgery required an incision on your sternum (breastbone), it will take about 6-8 weeks for your sternum to heal. During this time, you may do light household chores, such as laundry, shopping, cooking, light gardening, dusting, and washing dishes when you feel up to it.
Do not lift, push or pull objects heavier than 5 pounds until your doctor says it is okay to do so.
Try not to stand in one place for longer than 15 minutes. Do not sit for more than an hour; take a break for a few minutes and walk around or move your legs.
Physical Activities
You may do light, quick activities where your arms are above your shoulders, such as brushing your hair. But do not do any activities where your arms are above shoulder level for a long time, such as washing a window or dusting a high shelf. Do not do any activity that causes pain or pulling across your chest.
To get the most out of your day, plan to do the most important activities first. Don't try to do everything at once, and schedule unfinished activities for another day. Make sure that you get plenty of rest in between activities.
Climbing Stairs and Steps
Unless restricted by your doctor, it's okay for you to climb stairs and steps. Because you may be off-balanced after surgery, be careful and hold the handrail when walking up and down stairs. If you need to, stop and rest before you finish walking up or down a full flight. Try not to use the stairs immediately after surgery, and try to plan your activities so that you use the stairs only when necessary.
Fatigue
Fatigue is probably the number one patient complaint following surgery. Fatigue results from an extended lack of sleep while in the hospital, energy used by your body to heal its wounds, and energy used to fight off pain. To combat fatigue, listen to what your body is telling you. Space your activities to allow for rest periods. Take plenty of naps, walk regularly, eat well, and use your pain medication as needed. It's important that you rest and get a good night's sleep. Even if it's early in the night, if you feel tired, go to bed.
Driving and Riding in a Car
You should not drive for 3-4 weeks from the date of your surgery or while you are still taking narcotic pain pills. During this time your reaction time may be dulled, and if an incision was made on your sternum, your breastbone will still be healing. You may be a passenger in a car at any time. Make sure to wear your seat belt. You may cushion your incision with a soft towel or pillow.
Returning to Work
Returning to work depends upon the type of work you do and your energy level. It usually takes 4-6 weeks before most patients feel they have returned to their full energy level. The decision to return to work should be made jointly between you and your surgeon. You may want to consider working half days at first.
Traveling
Delay vacations or extended trips away from home for approximately 2-3 weeks, or until after the first post operative visit with your surgeon. Avoid air travel for two weeks from the date of your discharge. This restriction is designed to prevent you from being too far away from your surgeon should a problem arise.
Sex
Your surgeon will advise you accordingly.
Exercise
Proper exercise will help your healing and recovery, as well as increase your stamina, maintain your ideal weight by burning calories, and lower stress in your everyday life.
Tips for exercising:
Make sure you are not exercising too hard. Stop if you are exhausted, short of breath, feel dizzy, or have discomfort in your chest. Call your doctor if these symptoms persist and you are not able to do your regular exercises.
Your Diet
Along with exercise, eating healthy will speed up your recovery and healing. If your appetite is poor, try to eat smaller but more frequent meals.
Depending on your condition, your doctor or dietician may put you on a special diet. For example, patients with heart failure must follow a 2,000 mg low-sodium diet. Diabetic patients must follow a low-sugar, low-fat diet.
Tips to healthy eating:
Poor Appetite and Nausea
Many patients lose weight in the postoperative period. They complain of lack of appetite and mild nausea. Certain medications such as pain pills may cause nausea. Try eating small frequent amounts of food, and take medications on a full stomach unless otherwise directed. If you continue to experience nausea or lack of appetite, call your primary physician.
Constipation
Constipation is due to inactivity, limited fluid intake and lack of dietary fiber. It is aggravated by medications such as pain pills and iron. Eating plenty of fiber and fresh fruits, drinking 6-8 glasses of water daily and using your prescribed stool softener (Colace) as instructed can usually relieve constipation. If this does not work, Milk of Magnesia or Dulcolax may be helpful. Avoid Milk of Magnesia if you have kidney problems.
Caloric Restriction
Your total calories may be changed to increase, decrease, or maintain your weight as necessary. Being overweight increases the work of the heart. Your drug therapy may cause you to be hungry, you may eat more, and you may then gain weight. It is, therefore, very important that you pay attention to the total amount of food you take in. In addition to adding to the work of your heart, being overweight is associated with high levels of Triglycerides (fats) in the blood stream. Having a lot of fats in your blood increases the possibility of having the blood vessels of your heart become thickened. This will be described in more detail in the section on cholesterol and fats that follows.
Cholesterol and Saturated Fat Restriction
Cholesterol is a necessary fatty substance found in the body and many animal foods. Fats are concentrated sources of energy which occur in three forms: polyunsaturated, monounsaturated, and saturated. People who have large amounts of cholesterol and saturated fats in their blood are at increased risk of having thickening of their blood vessels throughout their bodies. This is because saturated fats and cholesterol in your blood will gather along the walls of your blood vessels causing them to narrow. If this narrowing becomes severe in the blood vessels of your heart, the blood supply to your heart will not get enough oxygen, and the cells of your heart will die. This is called "Coronary Artery Disease."
In addition to your diet, your medications may also increase the level of fats in your blood. Thus, in order to prevent coronary artery disease, your overall fat intake must be restricted after surgery. Generally, your overall fat intake should not be more than 30% of your total calories each day. Increasing the proportion of monounsaturated and polyunsaturated fat in your diet and decreasing your total saturated fat intake to less than 10% of your total fat intake will actually help to lower cholesterol and saturated fat levels in your blood. The aim of this diet is to keep the levels of fats in your blood within normal limits.