Background

A rare but not unknown complication of tracheostomy is tracheal stenosis (TS) and tracheomalacia (TM). This can be managed by serial dilatation, T-tubes. If this fails then the standard is resection and anastomosis(R&A). This patient had a BMI of 55 and multiple co-morbidities. He was being dilated q 2 mo and was not a candidate for R&A secondary to his size. He was referred by Otolaryngology(ENT) for consideration for Bariatric Surgery(BS). While were no previous reports of using BS to improve the outcomes of TS/TM, ENT had anticdotally seen patients who had mild improvements with medical weight loss.He is a 42-year old male who had had a trach for 6-years following a prolonged hospitalization for a mitral valve replacement (MVR), and myocardial infarction (MI). His other co-morbidities included congestive heart failure(CHF), Type-I diabetes mellitus(T1DM), obstructive sleep apnea(OSA) requiring 4LNC and BiPAP, renal insufficiency and cardiovascular accident(CVA). As his weight increased, he was requiring more frequent dilatations, and more frequent CHF hospitalizations. After 1-year working with the multi-disciplinary team, he underwent a sucessfulc Laparoscopic Vertical Sleeve Gastrectomy(LVSG). His co-morbidites did require a longer than normal hospital stay (LOS=11 days). He had no peri-operative complications. In the 31 mo. since surgery, he has lost to a BMI=47, TBWL=22%, he has had no admissions for CHF and the tracheal dilatations have gone from q 2 mo to q 6-8 mo. This is an excellent example of using BS to improve co-morbities to decrease health care expense utilization.