Benign Strictures

Inflammatory strictures requiring resection of the lung and adjacent main bronchus are rare and are almost always caused by tuberculosis (TB). Resection cannot be recommended in the presence of active TB or when active disease remains after resection. The adverse outcome under such circumstances is illustrated by Price Thomas's first patient to undergo a bronchoplastic procedure for benign disease.3 This patient, who had a stricture of the distal mainstem bronchus and diffuse lobar disease, continued to have positive sputum and required a completion pneumonectomy 6 months later. Pharmacologic control has led to virtual disappearance of bronchial TB in the United States and Western Europe, and series of benign bronchial strictures now originate from regions where TB remains endemic. Kato and colleagues reported 36 patients with tuberculous airway stenosis over a 36-year period.23 As shown in Figure 16-1,13 patients had left upper sleeve lobectomy, 12 patients had sleeve resection of the left main bronchus (of whom 2 underwent concomitant left upper lobectomy), 5 patients had right upper sleeve lobectomy, 2 patients had sleeve resection of the right intermediate bronchus, and each of the remaining 4 patients had, respectively, right sleeve superior segmentectomy of the lower lobe, sleeve resection of the trachea with concomitant left pneumonectomy, carinal resection with right upper sleeve lobectomy and middle lobectomy, and dilatation of the left main bronchus with a free skin graft reinforced with a steel wire. In another Japanese series, Watanabe and colleagues saw 19 benign strictures over a 21-year period.12 A histologic diagnosis of TB was made in 7, whereas the diagnosis was clinical in the others due to the typical location of the stricture. Of 12 patients undergoing surgical therapy, 4 underwent right upper and 3 had left upper sleeve lobectomy.

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