Single- vs double-stage laryngotracheal reconstruction.

OBJECTIVE: To compare single-stage laryngotracheal reconstruction (ssLTR) and double-stage LTR (dsLTR).

DESIGN: Retrospective medical record review.

SETTING: Tertiary care children's hospital.

PATIENTS: Seventy-one patients underwent 84 procedures (22 ssLTRs and 62 dsLTRs).

INTERVENTION: Review of preoperative disease severity and surgical outcomes for patients who underwent ssLTR vs dsLTR.

MAIN OUTCOME MEASURE: Operation-specific and overall decannulation rates.

RESULTS: Regarding ssLTRs, the mean grade of subglottic stenosis was 2.1 and the overall and operation-specific decannulation rates were 100% and 91%, respectively. The mean grade of subglottic stenosis for double-stage procedures was 2.9, and the overall and operation-specific decannulation rates were 93% and 68%, respectively. Patients who underwent ssLTR and dsLTR were further divided into early and late groups based on whether the posterior graft was sutured in place (early) or not (late). Overall and operation-specific decannulation rates were 100% and 89%, respectively, for the early single-stage group and 100% and 92% for the late group. Regarding the dsLTR group, overall and operation-specific decannulation rates were 88% and 42%, respectively, for the early group and 95% and 79% for the late group. Among all groups, there was no significant difference in overall decannulation rates (P > .05). Single-stage LTR offered an increased rate of operation-specific decannulation over dsLTR (P < .05). However, that difference was not significant between the late ssLTR and the late dsLTR groups (P > .05).

CONCLUSION: Careful assessment of preoperative disease severity and overall medical status will help surgeons choose between ssLTR and dsLTR, maximizing patient outcomes for both modalities.