Sarah Lewis, PharmD
What is tracheal surgery?
Tracheal surgery treats a variety of diseases, disorders and conditions that affect the function of the trachea (windpipe). This includes airway blockages, cancerous and noncancerous tumors, and problems with the larynx (voice box). Tracheal surgery can restore breathing function and improve quality of life for people with common or rare tracheal conditions.
Your trachea, or windpipe, starts in the neck just below the voice box and continues down behind the breastbone. It divides into two smaller tubes called bronchi the supply air to each lung. Your trachea is made of muscle, connective tissue, and rings of stiff cartilage. It also has a lining of moist mucus membranes. Your trachea expands and contracts slightly as you breathe.
Tracheal surgery is major surgery that has risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having tracheal surgery.
Types of tracheal surgery
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The types of tracheal surgery include:
Laryngotracheal reconstruction rebuilds and widens the windpipe using pieces of cartilage from another area or from a donor.
Laryngotracheal resection and reanastomosis removes a section of the windpipe and joins the two ends.
Tracheostomy creates a stoma (hole) in the front of the neck and through the trachea (windpipe). A tube is inserted in the opening. The tube provides an airway for breathing and a way to remove lung secretions and excess mucus.
Why is tracheal surgery performed?
Your doctor may recommend tracheal surgery to treat a disease, disorder or condition that affects the function of the trachea (windpipe). Tracheal is not a common surgery. Your doctor will only consider tracheal if less invasive treatments are ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion.
Your doctor may recommend tracheal surgery to treat:
Fistulas, or abnormal connections between the esophagus and windpipe
Stenosis, or narrowing of the windpipe
Subglottic stenosis, or narrowing of the area directly below the voice box
Tumors, including both cancerous and noncancerous growths
Who performs tracheal surgery?
Thoracic surgeons and otolaryngologists (pronounced “ōtō-lar-en-gäl-e-jests”) perform tracheal surgery. Thoracic surgeons specialize in the surgical treatment of diseases of the chest, including the blood vessels, heart, lungs, and esophagus. Thoracic surgeons may also be known as cardiothoracic surgeons. Otolaryngologists specialize in the medical and surgical care of the ears, nose and throat, and conditions affecting the head and neck. Otolaryngologists may also be known as ear, nose and throat (ENT) doctors.
How is tracheal surgery performed?
You tracheal surgery will be performed in a hospital. Your surgeon can use either an open surgery method or a minimally invasive method for your tracheal surgery.
Surgical approaches to tracheal surgery
Your surgeon will perform your tracheal surgery using one of the following approaches:
- Minimally invasive surgery involves inserting special instruments and an endoscope through at least two small incisions in your neck or chest. The endoscope is a thin, lighted instrument with a small camera. The camera transmits pictures of your trachea to a video screen. Your surgeon sees your trachea on the screen while performing surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your doctor will make small incisions instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery. Your doctor may also use a laser to assist in performing minimally invasive surgery.
- Open surgery involves making a large incision in the front of your neck or chest. The incision may include your breastbone if the surgical site is in the lower trachea. Open surgery allows your doctor to directly see and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different tracheal surgeries and ask why your surgeon will use a particular type of procedure for you.
Types of anesthesia
Your surgeon will perform your tracheal surgery using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain.
What to expect the day of your tracheal surgery
You may already be in the hospital before your tracheal surgery or you may go to the hospital the day of your tracheal surgery. The day of your surgery you can expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgical procedure as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and during your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of tracheal surgery?
As with all surgeries, tracheal surgery involves risks and complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Potential complications of tracheal surgery
Problems with tracheal are not common but can include:
Breakdown of the tissues that make up your windpipe
Collapsed lung, punctured lung, or pneumothorax. A pneumothorax is a condition in which air leaks into the space between your chest wall and the outer tissues of the lungs. This causes pain and shortness of breath.
Damage to your esophagus
Damage to your thyroid gland. Your thyroid gland is located on either side of your windpipe, just below your voice box.
Nerve damage to the nerves that control your voice box
Severe scarring of your windpipe that causes pain and difficulty breathing
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This may include respiratory therapy and speech therapy.
Informing your doctor if you are nursing or there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my tracheal surgery?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for tracheal surgery by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and can help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
Why do I need tracheal surgery? Are there any other options for treating my condition?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How should I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my tracheal surgery?
Knowing what to expect can help make your road to recovery after tracheal surgery as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until your vital signs are stable. Your care team will then move you to an intensive care unit (ICU). ICUs provide 24-hour specialized monitoring and care.
It may take a few hours until the major effects of anesthesia wear off and you are alert. When you wake up, you may have a breathing tube in your mouth and tubes and wires attached to your body. These allow your team to monitor your vital signs, drain bodily fluids, take blood, and give medications and fluids.
You will not be able to talk if you have a breathing tube. However, the care team usually removes it within 24 hours. You may have a sore throat from the breathing tube. This is usually temporary, but tell your care team if you are uncomfortable.
As you recover, you may move to a hospital room outside the ICU. Typically, hospital stays are longer after open tracheal surgery than after a minimally invasive procedure. You will likely stay in the hospital for several days.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, your age, and other factors. Your doctor will likely refer you to a respiratory therapy or speech therapy program to help you recover. Full recovery takes several weeks.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after tracheal surgery. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
How might tracheal surgery affect my everyday life?
Tracheal surgery may significantly reduce your symptoms so you can lead an active, normal life. Talk to your doctor if your tracheal surgery was part of treatment for an underlying condition so you understand your full treatment plan and ongoing care.
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