Abstract
Preventive surgery to combat aspiration by completely separating the airway from the gastrointestinal tract results in the loss of vocal function and does not necessarily guarantee postoperative oral intake. We conducted a retrospective evaluation of the patient background, surgical procedures, complications, pre- and postoperative nutritional management, and pre- and postoperative airway management in 33 patients who had undergone preventive surgery to combat aspiration at our department between January 2000 and December 2020. The most common underlying diseases were cerebrovascular disease in younger patients, and cerebrovascular disease and post-pharyngeal cancer in elderly patients. The surgical procedures performed were laryngotracheal separation in 10 cases, tracheoesophageal diversion in 12 cases, total laryngectomy in 7 cases, and glottal closure in 4 cases. Laryngotracheal separation tended to be selected for younger patients and patients with lower levels of independence. The complication rates did not differ depending on the surgical technique. Postoperative oral intake was associated with the degree of independence and presence of preoperative oral intake. Patients who required respiratory management, frequent aspiration of the sputum, and abnormal neck morphology, such as short neck, strained neck, cervical contracture, or stenosis of the tracheal stoma often required tracheal cannulation after the surgery. Good wound healing and postoperative freedom from cannulation or neck rests are important to avoid postoperative complications. Postoperative oral intake depends on the patient’s preoperative condition and state of progression of the underlying disease. When selecting the most appropriate procedure, the patient’s condition and the degree of invasiveness of the surgery should be considered, and the advantages and disadvantages of the surgery must be fully explained and understood by the patient and his/her family.
