An Experimental Study on Timing in Tracheal Stenosis Surgery

Abstract

Background TNF-alpha, IL-6, and TGF-beta are important bio mediators of the inflammatory process. This experimental study has investigated inflammatory biomarkers' efficacy to determine the appropriate period for anastomosis surgery in tracheal stenosis cases. Methods First, a pilot study was performed to determine the mean stenosis ratio (SR) after the surgical anastomosis. The trial was planned on 44 rats in four groups based on the pilot study's data. Tracheal inflammation and stenosis were created in each rat by using micro scissors. In rats of groups I, II, III, and IV, respectively, tracheal resection and anastomosis surgery were applied on the 2nd, 4th, 6th, 8th weeks after the damage. The animals were euthanized 8 weeks later, followed by histopathological assessment and analysis of TNF-alpha, IL-6, and TGF-beta as biochemical markers. Results Mean SR of the trachea were measured as 21.9 +/- 6.0%, 24.1 +/- 10.4%, 25.8 +/- 9.1%, and 19.6 +/- 9.2% for Groups I to IV, respectively. While Group III had the worst SR, Group IV had the best ratio ( p = 0.03). Group II had the highest values for the biochemical markers tested. We observed a statistically significant correlation between only histopathological changes and TNF-alpha from among the biochemical markers tested ( p = 0.02). It was found that high TNF-alpha levels were in a relationship with higher SR ( p = 0.01). Conclusion Tracheal anastomosis for post-traumatic stenosis is likely to be less successful during the 4th and 6th weeks after injury. High TNF-alpha levels are potentially predictive of lower surgical success. These results need to be confirmed by human studies.