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Double Stage Laryngotracheal Reconstruction

DSLTR 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 (anterior), the back of the airway (posterior), or both, to make the airway larger. 

“Double-stage” refers to the number of steps in the reconstruction. The first stage involves the rebuilding of the airway. If your child has a tracheotomy tube (trach), it will remain in place after the surgery, unlike in single stage laryngotracheal reconstruction (SSLTR/SSLTP) where the trach is removed during surgery. The second stage involves removing the stent and working toward getting your child’s trach out.

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 like a trach and stent, but combines both pieces in one. It looks like a T lying on its side, and has an upper and lower limb. One limb comes out of the neck. The T-tube holds the airway and graft in place while it heals. The nurses will teach you how to take care of the T-tube. The ENT doctor will decide how long the T-tube needs to stay in place. 

If your child does not have a feeding tube before surgery (e.g., NG, Gtube), an NG tube (feeding tube from the nose to the stomach) will be placed with a securing device at the time of surgery.

After Surgery

Your child will go to the recovery room (PACU) after surgery. You will be reunited with your child as soon as possible.

When your child’s breathing is comfortable and their pain level is acceptable, they will be transported to our complex airway unit. Your child will be cared for and closely monitored on the airway unit after surgery. Your child will have an IV while in the hospital. Their pain level will be checked and pain medications will be given to help keep your child comfortable. 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 for you before going home.

Being active helps healing. Daily activities are encouraged, like sitting up in a chair or walking.

The hospital stay is usually 5-7 days. Before going home, your child must: be breathing comfortably, tolerate oral or tube feedings, and have acceptable pain control.

You will also be shown any changes you need to make in your child's care, or review any care that you would like to discuss. It is important to know that while the stent is in place it blocks the upper part of your child’s airway. In an emergency, you must replace the trach tube.