Rohit Shishodia

A team of doctors from Department from Thoracic Surgery, ENT, and Pediatric Intensive Care and Anesthesia at Delhi’s Sir Ganga Ram Hospital (SGRH) managed to give new lease of life to 13-year-old boy from Rajasthan by carrying out Crico-tracheal resection, a complex surgery that lasted more than six hours.

Srikanth (name changed), the patient, from Rajasthan visited the hospital in the last week of April 2022. He had a Tracheostomy tube inserted in his breathing windpipe for more than 10 years. Due to a long period of Tracheostomy and a portion of missing windpipe, there was no airway for him to breathe normally. The child had neither spoken nor eaten normally for the last 7 years.

Dr Manish Munjal, Senior Consultant, Department of ENT, Sir Ganga Ram Hospital, “When I first saw the patient, I felt it was going to be a very complicated airway and voice box surgery which in my last 15 years of practice had not seen. This child had a complete 100% stenosis (blockage) of the Cricoid and Tracheal complex (air pipe). Due to this huge complication a single re-anastomosis (re-surgery) was going to be very difficult and challenging.”

Dr Sabyasachi Bal, Chairperson, Department of Thoracic Surgery, SGRH, said, “We decided to attempt complete ‘Crico-tracheal resection’ of the affected disease airway segment. This is a complicated and challenging surgery with high risk of failure which may lead sometimes to mortality (death). But the child did not have any other option and the same was explained to the family.”

Dr Munjal further added, “Since 4 cms of airway pipe near the voice box was completely destroyed and non-recoverable, our first challenge was to reduce this gap by bringing the upper and lower segments of airway as close as possible. For this ‘Laryngeal Drop’ procedure was performed to bring down the Voice Box from its normal position.”

Dr Sabyasachi Bal said, “Simultaneously when the voice box was being brought down, we released the lower part of windpipe from its surrounding attachment in the chest and pulled the windpipe towards the voice box.”

Dr Munjal added, “Finally, the most important and difficult part was to operate on badly stenosed (blocked) Cricoid bone. This is a horseshoe shaped bone below the voice box which contains the minute voice nerves on both the sides and is mainly responsible for voice and airway protection.

“We used a system of drills to widen the severely stenosed portion of Cricoids bone. We had to be extra careful to preserve the very minute laryngeal nerves (voice nerves). If these were damaged the voice would have never come back. Finally re-fashioned segments of both upper and lower sides of the airway were brought together and joined back,” he added.

Dr Anil Sachdev, Director Paediatrics Intensive Care, Department of Paediatrics, SGRH, “The child had a very high risk of airway leak into the chest wall, which could have been catastrophic. Therefore the child was kept in neck flexion (chin locked down towards the chest position) for 3 days. Also, he was kept on low pressure oxygen support so that he did not develop any traumatic air leak. He was also kept in ICU for 3 days and the recovery was uneventful.”

The child has now been discharged and is in stable condition.

Mr Amit Kumar (father of the child),“We are now very happy that our child who was neither speaking nor eating, missing school and his normal life, is now back at school. He has spoken for the first time after 7 years and most importantly taken his own breath without any outside help. He is also eating normally without a tube. We are very grateful to all the staff of Sir Ganga Ram Hospital for their miraculous surgery.”