An 85-day-old female infant with biliary atresia was admitted to Kobe Children's Hospital for Kasai's operation. At the time of endotracheal intubation, the tube was not able to be passed down. The tracheobronchoscopy immediately done showed a stenosis of the trachea from 1cm below the vocal cords. She underwent tracheoplasty instead of Kasai's operation, using costal cartilage graft in order to secure the patent airway for the subsequent management. She underwent Kasai's operation 3 days after the tracheoplasty. Revision of tracheoplasty was required for leakage on the 7th postoperative day. She was doing well without jaundice and without significant airway problems for the following 6 months. At the age of 9 months, restenosis of the grafted trachea was developed. Re-grafting of the costal cartilage to the stenotic trachea was done successfully by using pericardial rotational flap and pedicled omental patch to cover the grafted cartilage. She was finally discharged from the hospital without wheezing and jaundice at 13 months after the first operation. Two technical improvements were achieved through this operation; 1. Pedicied patch graft of the omentum, which is a new option for oxygen supply to the cartilage graft and for prevention of infection as well. 2. Application of hemoclip at the distal end of the graft which is very helpful as a radiopaque marker for the postoperative management.
