Abstract
Intractable aspiration is a life-threatening medical problem in patients with severe motor and intellectual disabilities (SMID). Laryngotracheal separation (LTS) is a surgical procedure for the treatment of intractable aspiration which separates the upper respiratory tract from the digestive tract. One hundred and thirty-eight patients received tracheostomy at our institution over two decades, and half of them were SMID. Over the last three years, our approach has been to avoid intractable aspiration with SMID and we have favored LTS rather than tracheostomy alone. We have performed two types of operation for LTS. The standard diversion procedure connects the upper trachea to the esophagus (diversion). The modified diversion (separation) includes closure of the proximal trachea and avoids tracheoesophageal anastomosis. Laryngotracheal separation was performed on 14 patients. A standard diversion was performed in 10 patients and a separation in 4. There were no operative complications recently. Eleven patients were safely transferred to home-care after their LTS. Twelve patients are still alive and 2 died some months after operation. One patient died from the primary disease and the other died of a tracheo-innominate artery fistula (TIAF). We recently experienced a patient who was at high risk of developing a TIAF. LTS is an effective operation, preventing intractable aspiration in patients with severe motor and intellectual disabilities and also increasing the patients' and families'QOL. The results are similar for diversion and separation, with the procedure chosen being related to the initial tracheostomy. LTS is one of the surgical options available to avoid intractable aspiration in SMID.
