Montgomery T-tube placement in the treatment of benign tracheal lesions

Introduction: Although surgery remains the gold standard for the treatment of benign tracheal stenosis, airway stenting may be indicated in theevent of complex lesions or associated diseases.We retrospectively investigated Montgomery T-tube placement as an alternative or complementarytreatment to surgery. Methods: From January 1984 to March 2008, 158 patients were treated for benign tracheal lesions. Eighty-three patientsunderwent airway resection and reconstruction as the only treatment. Seventy-five other patients with complex lesions or major associated diseaseswere treated with a T-tube and were retrospectively analysed. Seven of them had undergone unsuccessful treatment with Dumon stents. T-tubeplacement was the only procedure adopted in 51 patients with a contraindication to surgery (group I), a temporary measure in 15 patients prior tosurgery (group II), and in 9 patients (group III) for complications of airway reconstruction, 5 of whomwere referred fromother institutions. Results:Complications after T-tube placement were: stent dislocation in 3 (4%) patients, endoluminal granulomas in 14 (19%), subglottic edema in 3 (4%), andsputum retention in 7 (9%). Treatment of complications (tracheostomy cannula, steroid infiltration, Argon/LASER coagulation, and bronchoscopy)was required in 20 (27%) patients. In group I, the tubewas removed in 12 (24%) patients after 35.3 8.2months following resolution of the stenosis. Ingroup II, the tubes weremaintained in place before surgery for 17.1 4.8months. In group III, three stents were removed following tracheal healingafter 115.3 3.7months. After 5 years the stents were in place in 82%, 7% and 100% of the patients, respectively in groups I, II and III. Conclusions:Montgomery T-tube placement represents a useful option in patients with complex benign tracheal stenosis or associated diseases as an alternative orcomplementary treatment to surgery, and is effective even when other types of stents are unsuccessful.