Periprosthetic Leakage in Tracheoesophageal Prosthesis: Proposal of a Standardized Therapeutic Algorithm

Abstract

Objective Periprosthetic leakage represents the most demanding long-term complication in the voice prosthesis rehabilitation. The aim of this article is to discuss the various causes of periprosthetic leakage and to propose a systematic management algorithm. Study Design Retrospective cohort study. Setting Otolaryngology clinic of the University Polyclinic A. Gemelli–IRCCS Foundation. Methods The study included 115 patients with voice prosthesis who were treated from December 2014 to December 2019. All patients who experienced periprosthetic leakage were treated with the same step-by-step therapeutic approach until it was successful. Incidence, management, and success rate of every attempt are analyzed and discussed. Results Periprosthetic leakage was reported 330 times by 82 patients in 1374 clinic accesses. Radiotherapy, timing of tracheoesophageal puncture, and type of total laryngectomy (primary or salvage) did not influence the incidence of periprosthetic leakage. Salvage total laryngectomy increases the risk of more clinically relevant leakages. Conclusion By using a systematic algorithm with a step-by-step standardized approach, periprosthetic leakage management could become a less treacherous issue.

Commentary on Periprosthetic Leakage in Tracheoesophageal Prosthesis: Proposal of a Standardized Therapeutic Algorithm

“…Modification of the protocol for the management of periprosthetic leaks proposed by Parrilla et al 1 VP, voice prosthesis.…”

“…There is controversy regarding the factors that could influence the duration of the VP and the causes of periprosthetic leakage, 3 some of which are discussed in this article 1 . Apart from individual predisposition, various factors have been discussed in the literature 3 .…”

“…There is controversy regarding the factors that could influence the duration of the VP and the causes of periprosthetic leakage, 3 some of which are discussed in this article. 1 Apart from individual predisposition, various factors have been discussed in the literature. 3 A direct correlation between the incidence of severe fistula enlargement and reflux disease, confirmed by impedance-pH monitoring, has been demonstrated in several studies.…”

Regenerative Strategy for Persistent Periprosthetic Leakage around Tracheoesophageal Puncture: Is It an Effective Long-Term Solution?

“…The leakage around the prosthesis represents the main cause of failure in voice prosthesis rehabilitation after TL. It may result in aspiration of liquids, foods, saliva or, sometimes, in severe displacement of the prosthesis [ 15 ]. The frequency of leakage around TEP is estimated to be 7.2% [ 16 ], and is associated with a reduced health-related quality of life.…”

“…Among various substances that can be injected to obtain a volumetric augmentation, good results can be achieved with a medical silicone elastomer implant (Vox Implant ® , Bioplasty BV, Geleen, The Netherlands), hyaluronic acid, and autologous fat. Our team recently proposed a systematic and standardized algorithm to address this complication [ 15 ], as in the literature there is no consensus on the choice and timing of the different treatments. In our algorithm, fat grafting represents the sixth step after the aforementioned procedures.…”