Abstract
Purpose: The tracheal separation procedure has recently been employed to prevent recurrent aspiration pneumonia, which can be life-threatening especially in neurologically impaired children. The effectiveness and safety of this procedure were examined. Methods: The records of 11 neurologically impaired patients with intractable aspiration who underwent the tracheal separation procedure with (8 patients) or without (3 patients) tracheoesophageal anastomosis between March 2004 and August 2005 were retrospectively reviewed, focusing on their clinical courses, complications, and outcomes. In patients with gastroesophageal reflux (GER) associated with aspiration symptoms, we carried out fundoplication first unless the breathing problem was serious. The patients who subsequently developed symptoms for severe aspiration underwent the tracheal separation procedure. Results: Frequency of oral and tracheal management for aspirated saliva decreased after the operation (preoperative frequency: 5.4±2.0/day, postoperative frequency: 4.4±1.4/day, p=0.066). Degree of oxygen saturation improved (preoperative level: 93.8±3.3%, postoperative level: 98.0±1.6%, p=0.002). Incidence of aspiration pneumonia decreased postoperatively. Four patients who developed respiratory symptoms associated with GER underwent tracheal separation following fundoplication. Postoperative complications were one tracheoesophageal anastomotic leakage and one subcutaneous hematoma. Both were successfully treated by drainage. At the time of writing, 5-22 months after the operations, all patients were alive. Conclusions: The tracheal separation procedure was safe and effective. This procedure not only prevented aspiration pneumonia but also improved the QOL of both patients and caregivers. Carrying out fundoplication for GER first benefited patients' families providing enough time to realize the necessity of the tracheal separation procedure.
