Hilar Release

A hilar release has only rarely been performed for benign stenosis of the upper or midtrachea, since it hugely increases the extent of surgery otherwise planned as a cervicomediastinal procedure. The gain in length

Tracheal Stenosis
figure 24-20 Recapture of tracheal length for recontruction where a stoma has been made just proximal to a lengthy stenosis. A, Dotted lines indicate the excessively long resection that would be required. B, The stoma is allowed to heal prior to resection (C).

over mobilization of the pretracheal plane, cervical flexion, and laryngeal release is not great, even when release is bilateral. Accomplishing bilateral hilar release is difficult, requiring in such a patient a right pleurotomy via complete sternotomy and a T incision into the left fourth interspace or intrapericardial exposure on the left (see Chapter 28, "Reconstruction of the Lower Trachea [Transthoracic] and Procedures for Extended Resection"). Although this may be justified for neoplasm in a patient who can tolerate the procedure, acceptance of T tube restoration of an airway may be more judicious for a lengthy benign stenosis, except in a young and fit patient. In such an extreme circumstance, laryngeal release is often also useful if the lesion involves the midtrachea.

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