Abstract
We have prepared two types of laryngotracheal separation with an end-tracheostomy to completely prevent pulmonary aspiration for patients with tracheostomy. The type I is laryngotracheal separation with a removal of exsisting tacheostomy. The type II is tracheostomy-preserving laryngotracheal separation. Between June 2009 and July 2016, 17 patients with a tracheostomy underwent laryngotracheal separation and the usefulness of these two procedures was evaluated retrospectively. The type I procedure was performed in 10 cases and type II in 7. Tracheoesophageal anastomosis was done in 6 patients and one case in the type I and type II, respectively. The average operation time was 269 ± 62 minutes in the type I and 160 ± 50 minutes in the type II. The intraoperative blood loss was 120±55g and 31±45g in the type I and type II, respectively. Tracheo-innominate artery fistula and lung atelectasis developed in one each patient in the type I, and failure of the tracheal closure and orifice stenosis of the tracheostomy due to skin tag occurred in one each patient in the type II. Since the type II procedure needed no exfoliation around the lung side trachea, which resulted in a narrow area exfoliation during surgery, the type II method showed shorter operation time and less intraoperative blood loss, compared to the type I. In addition, the risk of occurrence of tracheo-innominate fistula was considered to be low in the type II, equivalent following a tracheotomy, because this procedure can be accomplished without peeling the lung side trachea or causing tracheal deviation. The tracheostomy-preserving laryngotracheal separation could be a treatment of choice for patients with an intractable pulmonary aspiration after receiving tracheostomy.
