Current status of the myomucosal tracheoesophageal shunt

✍ Scribed by Strome, Marshall ;Brasnu, Daniel ;Laccourreye, Henri

• Publisher: Wiley (John Wiley & Sons)
• Year: 1988
• Weight: 416 KB
• Volume: 10
• Category: Article
• ISSN: 0148-6403
• DOI: 10.1002/hed.2890100817

✦ Synopsis

Differences of opinion persist as to the most functional method of vocal rehabilitation following total laryngectomy. The tracheoesophageal puncture (TEP) has an overall success rate approximating To%, but substantive reported complications and concerns as to vocal quality have led some surgeons and speech pathologists to question the efficacy of this procedure. The myomucosal tracheoesophageal shunt represents the evolution and refinement of older concepts. It is created at the time of ablation, a one-stage procedure, and has the potential to function independently, yet can accommodate a prosthesis. Once this shunt is functional, spontaneous closure is rare and aspiration when present has not been clinically significant. We report data from 31 patients, 9 from the originating group and 22 from the Hospital Laennec. Seven of nine shunts from the originating group are functional. Six patients remain tumorfree for more than 2 years, and two others are disease-free at less than 2 years. Seven shunts function in the Laennec series without a prosthesis. The seven successes were achieved in the last 13 procedures performed, after technique modifications. Four of 22 patients had flap (shunt) necrosis, two of whom had extensive paratracheal resections and two of whom had diabe-