Balloon-assisted placement of rib graft in endoscopic posterior cricoid split; a new technique.

Objective: This study aims to compare the outcomes of balloon-assisted rib graft placement with traditional graft placement in Endoscopic Posterior Cricoid Split with Rib Graft Placement (EPCS/RG).

Methods: We conducted a retrospective analysis of 23 patients who underwent EPCS/RG by a single senior surgeon at King Saud University Medical City from 2017 to 2024. Data were collected on demographics, surgical approach, and operative time. Statistical analyses included Mann-Whitney U tests for continuous variables and Fisher's exact test for categorical variables, with significance set at p-value < 0.05. Univariate binary regression was reported as Odds Ratio (OR) with 95% Confidence Interval (CI).

Results: Of the 23 cases, 16 (69.5%) utilized the balloon-assisted technique. Age ranged from 8 months to 19 years (median age 10 years). Older age was significantly associated with the balloon-assisted technique (OR 1.627, p-value 0.022). Balloon-assisted cases demonstrated longer split lengths and graft widths, though data limitations hindered definitive conclusions. Tracheostomy was avoided in 65.2% of cases. The operative duration averaged 240 min, showing no significant difference between balloon-assisted or the standard techniques (OR 1.015, CI 0.993-1.038, p-value 0.177).

Conclusion: Balloon-assisted rib graft placement in EPCS/RG facilitates surgical approach, particularly in older patients. It does not extend operative duration, offering a promising advancement in airway surgery.

Level of evidence: Level 3.