OBJECTIVE: To determine the outcome of laryngotracheal separation (LTS) in 60 patients in terms of the control and prevention of severe and persistent aspiration, morbidity and mortality, reversibility rate, and the influence of the presence of a tracheostomy.
STUDY DESIGN: Retrospective study.
RESULTS: LTS showed significant efficacy rates in terms of both treatment (87%) and prevention (100%) of pulmonary aspiration. Twenty-six (43%) patients developed postoperative complications. A tracheocutaneous fistula of the proximal tracheal stump was observed in 14 (23%) patients and was the most frequent complication, especially in patients with a therapeutic indication (P = 0.028) and in those with a tracheostomy (P = 0.058). Reversion of LTS was possible in 12 (20%) patients, mainly those with a prophylactic indication (P = 0.005). However, the rates of complications (58%) and inefficacy (27%) of reversion surgery were high.
CONCLUSION: LTS is effective in the elimination and prevention of clinically intractable aspiration. The procedure is potentially reversible. However, the frequency of complications for both LTS and reversion surgery is significant.
Get full access to this article
View all access options for this article.
References
1.
LogemannJA. Aspiration in head and neck surgical patientsAnn Otol Rhinol Laryngol1985;94:373–376. (Grade C)
2.
SnydermanCHJohnsonJT. Laryngotracheal separation for intractable aspirationAnn Otol Rhinol Laryngol1988;97:466–470. (Grade C)
3.
HalamaAR. Surgical treatment of oropharyngeal swallowing disordersActa Otorhinolaryngol Belg1994;48:217–227. (Grade C)
4.
EiseleDWYaringtonCTLindemanRC. Indications for the tracheoesophageal diversion procedure and the laryngotracheal separation procedureAnn Otol Rhinol Laryngol1988;97:471–475. (Grade C)
5.
HabalMBMurrayJE. Surgical treatment of life-endangering chronic aspiration pneumonia. Use of an epiglottic flap to the arytenoidsPlast Reconstr Surg1972;49:305–311. (Grade C)
6.
MontgomeryW. Surgery to prevent aspirationArch Otolaryngol1975;101:679–682. (Grade C)
7.
SasakiCTMilmoeGYanagisawaE. Surgical closure of the larynx for intractable aspirationArch Otolaryngol1980;106:422–423. (Grade C)
8.
LindemanRC. Diverting the paralysed larynx: A reversible procedure for intractable aspirationLaryngoscope1975;85:157–180. (Grade C)
9.
LindemanRCYaringtonCTJrSuttonD. Clinical experience with the tracheoesophageal anastomosis for intractable aspirationAnn Otol Rhinol Laryngol1976;85:609–612. (Grade C)
10.
EiblingDESnydermanCHEiblingC. Laryngotracheal separation for intractable aspiration: a retrospective review of 34 patientsLaryngoscope1995;105:83–85. (Grade C)
11.
PaixãoRMSallesJMPZocrattoOB. Cirurgia de separação laringotraqueal: indicação clássica, novas indicações e resultados ao longo de 10 anos com seu emprego. In: Anais do XVII Congresso Brasileiro de Cirurgia de Cabeça e Pescoço. Belo Horizonte; Set., 1999. p. 64. (Grade D)
12.
PaixãoRM. Quais as indicações e técnicas cirúrgicas para o tratamento da aspiração persistente? In: CastroLPSavassi-RochaPRCunha-MeloJRCostaMMB, editors. Tópicos em gastroenterologia 10: deglutição e disfagia.Rio de Janeiro: MEDSI;2000. pp. 215–223. (Grade D)
13.
LombardELCarrauRL. Tracheo-tracheal puncture for voice rehabilitation after laryngotracheal separationAm J Otolaryngol2001;22: 176–178. (Grade D)
14.
EiseleDWYaringtonCTLindemanRC. The tracheoesophageal diversion and laryngotracheal separation procedures for intractable aspirationAm J Surg1989;157:230–236. (Grade C)
15.
YamanaTKitanoHHanamitsuM. Clinical outcome of laryngotracheal separation for intractable aspiration pneumoniaORL J Otorhinolaryngol Relat Spec2001;63:321–324. (Grade C)
16.
TakanoYSugaMSakamotoO. Satisfaction of patients treated surgically for intractable aspirationChest1999;116:1251–1256. (Grade C)
17.
ZietekEJaworowskaEMatyjaG. Laryngotracheal separation procedure after oncological pharyngeal and laryngeal operationsOtolaryngol Pol2001;55:359–362. (Grade D)
18.
TakamizawaSTsugawaCNishijimaE. Laryngotracheal separation for intractable aspiration pneumonia in neurologically impaired children: experience with 11 casesJ Pediatr Surg2003;38:975–977. (Grade C)
