Intractable pulmonary aspiration in children: Which operation?

Laryngotracheal separation surgery for intractable aspiration: Our experience with 12 patients

“…In our study, the success of the procedure in controlling aspiration was 100%, similar to that found in other reports [7,15,16,20]. No other procedure for aspiration control has been able to demonstrate such effectiveness.…”

“…Treatment of aspiration consists of conservative measures or surgical management should the former fail. Conservative treatment includes a wide range of strategies and maneuvers including alternative feeding route by nasogastric or gastrostomy tubes, parenteral hyperalimentation, swallowing rehabilitation, food texture changes, head position adjustment or treatment with medications such as anti-emetics, anti-reflux drugs and antibiotics [7]. While these strategies can be successful in children who can handle their own secretions and do not present with severe pulmonary complications, they often fail or are impractical in neurologically impaired children.…”

“…Total laryngectomy has often been proposed as the surgery of choice for control of chronic aspiration in patients with poor prognosis for neurological recovery, impaired wound healing or associated medical problems [7]. This is an extensive procedure with a high rate of pharyngo-cutaneous fistula formation, irreversibility, loss of phonation, permanent tracheostoma and cosmetic deformity.…”

Definitive techniques for intractable aspiration pneumonia

“…Though we read with great interest the article by Hafidh et al [1], there are concerns regarding the conclusion drawn by the authors about the treatment of intractable aspiration.…”

Advances in the diagnosis and management of chronic pulmonary aspiration in children

“…There is a complete loss of phonation and the child is left with a permanent tracheostomy. Frequency of tracheocutaneous fistula development ranges 0-38% [128,129], and stenosis of the stoma site has been reported [128,130]. Even if this procedure is performed without a complete laryngectomy, laryngotracheal separation may not be reversible.…”