Tracheobronchomalacia (TBM) Surgery, or Tracheobronchoplasty 

Helping You Breathe Easier for Life

Beth Israel Deaconess Medical Center (BIDMC) provides highly specialized care for tracheobronchomalacia (TBM). We are world leaders in diagnosing and treating this complex condition.

If you have severe TBM, your care team may recommend you undergo tracheobronchoplasty. This procedure offers effective and permanent treatment for TBM.

Co-Managing Other Health Conditions

To ensure that you will benefit from surgery, our multidisciplinary team will first determine whether you have other conditions that commonly occur in addition to TBM. If you have other conditions, you’ll need to receive treatment for them before undergoing TBM surgery. For this reason, we will assess:

• Your vocal cord health.
• Whether you have gastroesophageal reflux disease (GERD).
• Whether you have other lung disorders including asthma, COPD or emphysema.

What to Expect

Specialists in our Chest Disease Center also work to determine whether you are healthy enough to undergo surgery.

Stent Trial

The final step in determining whether you will benefit from surgery is a one- to two-week stent trial. The stent will keep your airways open, much as a cardiac stent keeps blood vessels open. This mimics what happens to your airways after surgery. Therefore, the trial will give you some idea of how much your symptoms will improve after surgery.

During the stent trial:

• We will use questionnaires to ask questions about your shortness of breath, quality of life and cough.
• We will monitor how you are doing.
• You’ll return to the TBM Clinic for follow-up care.
• You’ll undergo physiological evaluation using tests to assess lung function and 6-minute walking capacity.

When the trial is over, we remove the stent. We prefer not to implant stents permanently, as they can cause irritation or become infected. Surgery offers a better long-term solution for most patients.

Tracheobronchoplasty

If your symptoms improve during the stent trial and your overall health suggests you may benefit from surgery, we will schedule you for tracheobronchoplasty. Learn about preparing for surgery at BIDMC.

Depending on your specific case, we have two possible approaches:

• The robotic-assisted approach consists of the surgeon making small incisions (cuts) in the chest wall. They insert instruments to assist in repairing the affected area.
• The open approach consists of a standard larger incision and the surgeon opens the chest wall to reach the airways.

In both methods, the surgeon stitches sections of mesh at multiple points on the outside of the floppy airway. This works to stabilize it (much like a splint will keep a broken bone steady). As you heal, scar tissue forms around the mesh, making it stable. 

After Tracheobronchoplasty

You will spend several days in the intensive care unit (ICU), followed by a longer stay in a normal hospital room. Learn about what to expect after surgery. After we discharge you from the hospital, we will monitor your recovery closely. If you come to BIDMC from out of state, you may need to find temporary housing in the area for the first month after discharge.

Post-Surgery Monitoring and Ongoing Care

We want to ensure that you recover as well as possible. For that reason, we ask that you return three months after surgery for evaluation. From then on, we will ask you to return to the TBM clinic once a year, so that we can continue to monitor your recovery.