Primary tracheoesophageal puncture and cricopharyngeal myotomy in stapler-assisted total laryngectomy

A Novel Technique: Stapler-Assisted Total Laryngectomy with Concurrent Tracheoesophageal Prosthesis Insertion

Introduction

Stapling-assisted closure of pharyngeal mucosa during total laryngectomy was described in 1973.Few authors have demonstrated that this technique provides a faster and more reliable pharyngeal closure with ashorter operative period. However, the simultaneous placement of tracheoesophageal prostheses is quitechallenging and affects the patient's speech rehabilitation.

Aim

We are reporting our novel concurrent tracheoesophageal prosthesis insertion technique in stapler-assistedtotal laryngectomy.

Methods

A patient with locally advanced laryngeal cancer underwent total laryngectomy with stapler-assistedcloser and concurrent primary tracheoesophageal prosthesis. In a closed stapler-assisted reconstruction of theneopharynx, an inflate folye ballon was utilised to identify the ideal TEP puncture site.

Results

The immediate postop course was uneventful, and the patient acquired fluent alaryngeal speech after thespeech rehabilitation.

Conclusion

Our novel technique of concurrent tracheoesophageal prosthesis insertion in stapler-assisted totallaryngectomy is practically simple and shortens the operative time.

Primary tracheoesophageal puncture in stapler-assisted laryngeal closure: a surgical modification

With the advancements in the medical field, many innovations in medical devices have happened. Using a surgical stapler to close the laryngectomy defect without opening the pharynx is particularly advantageous in a total laryngectomy (TL). However, performing the tracheoesophageal puncture (TEP) during stapler closure of the larynx has not been widely advocated, due to the fear of complications related to the procedure.We treated two male patients with advanced glottic malignancy who underwent a TL. To restore their ability to speak, we performed a primary TEP and immediate voice prosthesis placement. After the TEP, we closed the larynx using a stapler. The surgical technique used in this procedure has been thoroughly explained.The use of a surgical stapler for pharyngeal closure during a TL has several advantages, particularly with regard to the duration of surgery. The current techniques appear to be promising in reducing TEP-related complications during stapler-assisted laryngeal closure.

Novel stapler-assisted technique for closure of persistent tracheoesophageal puncture fistula

Tracheoesophageal puncture (TEP) is a reliable method to restore voice and is an important part of voice rehabilitation following laryngectomy. However, complications following this procedure, including peri-prosthetic leakage and resulting aspiration pneumonia, may necessitate surgical closure. In this study, we present an effective and reliable method for TEP closure using a stapler-assisted technique. Case series study for patients who underwent stapler-assisted TEP closure reviewed from 2017 to 2021. All five patients had successful closure of their TEP tract without further leakage. No postoperative bleeding, wound infection, or esophageal stenosis occurred. One patient had postoperative stomal stenosis. The stapler-assisted technique for TEP closure is easy, quick, and effective. The reliability and quick return to oral intake post-operatively make it a preferable option over previous techniques.

Pharyngeal closure after a total laryngectomy: mechanical versus manual technique

OBJECTIVE

To verify the main advantages and drawbacks of mechanical suturing for pharyngeal closure after total laryngectomy versus a manual suturing technique.

METHODS

A retrospective review was carried out of 126 total laryngectomies performed between 2008 and 2018. Manual closure was performed in 80 cases (63.5 per cent) and mechanical suturing was performed in 46 cases (36.5 per cent).

RESULTS

Mechanical suturing was used significantly more frequently in patients with: glottic tumours (p = 0.008), less local tumour extension (p = 0.017) and less pre-operative morbidity (p = 0.014). There were no significant differences in the incidence of pharyngocutaneous fistula between the manual suture group (16.3 per cent) and the mechanical suture group (13.0 per cent) (p = 0.628). None of the patients treated with mechanical suturing had positive surgical margins. Cancer-specific survival for the mechanical suture group was higher than that for the manual suture group (p = 0.009).

CONCLUSION

Mechanical suturing of the pharynx after total laryngectomy is an oncologically safe technique if used in suitable cases.