What is Double Stage Laryngotracheal Reconstruction (DSLTR)?
DSLTP is a surgery in which the airway is made larger by placing a graft in an area of the airway that is too narrow. Most grafts are made of ear cartilage, thyroid cartilage or rib cartilage.
The ENT doctor (ear, nose and throat) will decide what type of graft is best for your child.
The ENT doctor will decide where the graft needs to be placed:
- In the front of the airway (also called anterior)
- The back of the airway (also called posterior)
- Both, in order to make the airway larger
About the Surgery
If your child has a tracheotomy tube (trach), it will remain in place after the surgery, unlike in single stage laryngotracheal reconstruction (SSLTR), where the trach is removed during surgery.
There will be an incision in the neck where the surgery was done. A small drain will be in the neck to allow fluid and air to drain after the surgery.
If rib cartilage is used, there will be a small incision on the chest and a drain will be in place there after the surgery. The ENT doctor will decide how long the drains will remain in place.
A stent is a cylindrical tube placed and secured in the airway during surgery above the trach. The stent holds the graft in place while it heals so it does not shrink back down. The ENT doctor will decide how long the stent needs to stay in place.
The ENT doctor may decide to use a T-tube instead of using a trach and stent. A T-tube is similar to a trach and stent, but it is all in one. It looks like a "T" lying on its side, and has an upper and lower limb, and a limb comes out of the neck. The T-tube holds the airway and graft in place while it heals. You will be educated by the nurses on how to take care of the T-tube. The ENT doctor will decide how long the T-tube needs to stay in place.
“Double stage” refers to the number of steps in the reconstruction.
If your child does not have a feeding tube before surgery (ie NG, Gtube), an NG tube (feeding tube from the nose to the stomach) will be placed with a securement device at the time of surgery in the operating room.
Your child will be cared for and closely monitored on the airway unit after surgery. Children with a stent or T-tube often have difficulty swallowing after the surgery. Increased secretions, drooling, and coughing is common. A speech therapist will work with your child to assist with swallowing and eating after the surgery. They will check swallowing before your child eats by mouth to make sure that it is safe. Tube feeds are started after surgery (if the tube is new for your child it may take a couple days to adjust to the feedings). It is not uncommon to go home with a feeding tube still in place. We will have a feeding plan in place before going home.
You will also be shown changes in your child's care or review any care that you may want or need. As your child continues to progress with breathing on his / her own, tolerating feedings, and healing overall, he / she will be cared for in the hospital until ready for discharge.