31/01/2026
“Double hitch stitch is a novel technique for fixation of tracheal stent in a case of Excessive Dynamic Airway
Collapse (EDAC)”
1. Diagnostic confirmation and procedural indication
Excessive Dynamic Airway Collapse (EDAC) is confirmed via dynamic flexible bronchoscopy and/or expiratory-phase computed tomography, demonstrating significant posterior membranous wall invagination during expiration. Given the severity of functional airway compromise, endoluminal tracheal stabilization with a silicone stent is indicated.
2. Rigid bronchoscopic airway assessment
The procedure is performed under general anesthesia using rigid bronchoscopy, allowing comprehensive evaluation of the tracheal lumen, characterization of the malacic segment, and optimization of airway clearance. Stent length and diameter are selected based on bronchoscopic measurements.
3. Endoluminal deployment of silicone tracheal stent
A silicone tracheal stent is deployed across the affected segment to provide circumferential airway splinting and mitigate expiratory luminal collapse. Stent expansion, alignment, and luminal apposition are confirmed bronchoscopically.
4. Planning of trans-tracheal fixation sites
Two fixation points are identified along the anterior tracheal wall, typically corresponding to the proximal and distal thirds of the stent. These sites are chosen to enhance anchoring strength while minimizing localized tracheal wall stress.
5. Primary hitch-stitch fixation
Under continuous bronchoscopic guidance, a trans-tracheal suture fixation is performed by passing a suture through the anterior tracheal wall and stent, exteriorizing it through the skin, and securing it externally. This constitutes the primary hitch-stitch, providing axial stabilization and migration prevention.
6. Secondary hitch-stitch fixation (Double hitch-stitch configuration)
A second trans-tracheal suture is placed at a separate stent level in an analogous fashion. This double hitch-stitch configuration enhances stent fixation by distributing tensile forces, improving resistance to displacement, and providing additional stability in the setting of marked dynamic airway collapse.
7. Post-fixation bronchoscopic reassessment
Repeat bronchoscopic evaluation confirms adequate airway patency, stable stent position, preserved mucosal integrity, and absence of immediate complications such as bleeding, mucosal injury, or stent deformation.
8. Post-procedural monitoring and follow-up
The patient is monitored for clinical response, fixation site integrity, and delayed complications. Interval surveillance bronchoscopy is planned to assess long-term stent stability and airway dynamics.
Thank you
Dr. Anoop MP
Interventional Pulmonologist
Senior consultant & HOD Dept. Pulmonology
Aster MIMS Hospital
Kasturba Medical College, Mangalore Aster MIMS Calicut Intervention Institute of Pulmonology Allergy
