Bronchoscopic Management of Mesh Erosion Following Tracheobronchoplasty in Patients with Severe Tracheobronchomalacia: A Case Series.

Abstract

<h4>Background</h4>Mesh erosion is an increasingly recognized delayed complication of tracheobronchoplasty (TBP) for severe tracheobronchomalacia (TBM). While historically reported in fewer than 0.5% of cases, recent case series with extended follow-up have identified isolated events, including one erosion among 12 patients (8.3%). This case series illustrates the endoscopic management of mesh erosion in four patients, emphasizing bronchoscopic resection as a viable alternative to surgical removal in select cases.<h4>Case presentation</h4>Four patients (ages 49-78) with severe TBM underwent TBP using posterior tracheobronchial mesh. All developed delayed-onset respiratory symptoms including progressive dyspnea, chronic cough, and recurrent infections. Comorbidities included severe COPD, diabetes, GERD, and immunosuppressive conditions. CT imaging raised concern for airway compromise; diagnostic bronchoscopy confirmed mesh erosion into the airway lumen in all cases, with tracheal and bronchial involvement and varying degrees of obstruction. Therapeutic bronchoscopy was performed using a combined rigid and flexible approach. Mesh segments eroding into the airway were selectively resected using biopsy forceps and laparoscopic scissors under direct visualization. Procedures were well-tolerated, with no intraoperative complications. In two patients, airway patency improved to >90% post-intervention. The remaining patients underwent partial mesh trimming, achieving symptomatic and infectious control. Adjunctive therapies included culture-guided antibiotics, mucociliary clearance optimization, and GERD management. One patient underwent hyperbaric oxygen therapy for mucosal healing. All patients remained clinically stable on follow-up, with improved symptom scores and no need for repeat bronchoscopic resection to date.<h4>Conclusions</h4>Bronchoscopic resection of eroded mesh following tracheobronchoplasty (TBP) is a safe, effective, and less invasive option that can relieve airway obstruction, reduce infection burden, improve symptoms and quality of life in carefully selected patients. Timely diagnosis through imaging and endoscopic assessment is essential, and management should be guided by a multidisciplinary approach.