1998 Volume 2 Issue 1 Pages 29-35
During the period between August，1990 and March，1996，a total of 106 patients with recurrent pneumonia due to accidental swallowing underwent tracheoesophageal diversion developed by Lindeman in 1975．Their underlying diseases included cerebral palsy and nerve degeneration． Of these 106 patients， 31 were treated in the department of neurology， 73 in the department of pediatric neurology and two in the department of neurosurgery．The trachea was horizontally divided either between the second and third tracheal rings or between the third and fourth tracheal rings． The tracheal stump on the laryngeal side was united with esophagus by end-to-side anastomosis and the tracheal stump on the pulmonary side was treated by tracheostomy．The purposes of the present study included the evaluation of various patients according to several parameters， the selection of the patients with pneumonia due to accidental swallowing who could be best treated by tracheoesophageal diversion and the determination of the right timing of conducting this surgical procedure． Furthermore the conditions for the selection of the patients who were advised to undergo complete laryngectomy were discussed．After the surgical treatment， accidental swallowing disappeared and the incidence of pneumonia decreased in 80 of 85 cases． The respiratory function and the sleeping and awakening rhythm were improved in most of the cases， The percentages of the patients who were allowed to orally take all the food were 58% （14/24） in the department of neurology and 21%（13/61） in the department of pediatric neurology． Whether the oral intake is allowed or not depends on the individual neurological potency． After the operation， two patients started to utter voice and got into communication by using swallowing and eructation． The dominant postoperative complication was the ruptured suture at the site of trachea-to-esophagus anastomosis． Five of 18 ruptured suture patients underwent complete laryngectomy． These patients were characterized by high tension due to the postoperative difficulty in maintaining the rest of neck， enhancement of vomiting and cough reflex and elderly males with rigid tracheal cartilages．Since the clinical application of tracheoesophageal diversion， an increasing number of patients have undergone this surgical therapy because of the following reasons： reconstructible surgical treatment， patients’ and their family members’ high tolerance toward the surgical treatment which allows the preservation of larynx， the relative increase in the number of severely disabled infants because of the improvement of survival rate and the demand for the improvement of the quality of life of the patients suffering from chronic diseases (e.g. respiratory care at home)．The present study demonstrated that tracheoesophageal diversion was a reconstructible surgical procedure which induced few severe complications and that this surgical procedure more effectively prevented accidental swallowing than other surgical therapy． Consequently we regarded tracheoesophageal diversion as an excellent surgical treatment．
