Surgical Closure of Tracheoesophageal Puncture Without a Flap Interposition

Neves, João Fonseca; Nobre, Ana Rita; Portugal, Edite; Branquinho, Francisco

doi:10.1177/0194599820931077

Cited by 4 publications

(8 citation statements)

References 5 publications

(17 reference statements)

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“…Seventeen studies reporting outcomes of 117 patients were included in the quantitative analysis. 9 11 25 28 30 32 33 35 38 40 44 46 47 48 49 52 The overall incidence of unsuccessful TEP closure was 6% (95% CI 1–13%) ( Fig. 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…1 ). 9 10 11 13 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 Using the OCEBM, 33 studies had a level of evidence of 4. No discrepancies during quality assessment occurred.…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, as the tract is not divided, there is a hypothetical lower risk of suture slippage and subsequent infection in the potential space between the pharynx and trachea. 35 46…”

Section: Discussionmentioning

confidence: 99%

“…9 Nonetheless, repeated mucosal resections are only possible for this method if there is enough tracheal mucosa present. 46…”

Section: Discussionmentioning

confidence: 99%

“…Neves et al equally transected the tract and separately sutured esophagus and trachea with the addition of performing a vertical incision across the first tracheal ring to facilitate a tension-free suture on the posterior tracheal wall. 46 Gozen et al and Neves et al externally reinforced the stoma to avoid stomal stenosis in radiated patients which may be advantageous to avoid further surgeries. 9 46 In this review, primary closure yielded a 9% (95% CI < 1–28%) TEP recurrence rate which was attributed to the cytotoxic effect of radiotherapy and recanalization of the tract.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis

et al. 2022

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Tracheoesophageal puncture (TEP) and voice prosthesis insertion following laryngectomy may fail to form an adequate seal. When spontaneous closure of the fistula tract does not occur after conservative measures, surgical closure is required. The purpose of this study was to summarize the available evidence on surgical methods for TEP site closure.A comprehensive search across PubMed, Web of Science, SCOPUS, and Cochrane was performed to identify studies describing surgical techniques, outcomes, and complications for TEP closure. We evaluated the rate of unsuccessful TEP closure after surgical management. A meta-analysis with a random-effect method was performed.Thirty-four studies reporting on 144 patients satisfied inclusion criteria. The overall incidence of an unsuccessful TEP surgical closure was 6% (95% confidence interval [CI] 1–13%). Subgroup analysis showed an unsuccessful TEP closure rate for silicone button of 8% (95% CI < 1–43%), 7% (95% CI < 1–34%) for dermal graft interposition, < 1% (95% CI < 1–37%) for radial forearm free flap, < 1% (95% CI < 1–52%) for ligation of the fistula, 17% (95% CI < 1–64%) for interposition of a deltopectoral flap, 9% (95% CI < 1–28%) for primary closure, and 2% (95% CI < 1–20%) for interposition of a sternocleidomastoid muscle flap.Critical assessment of the reconstructive modality should take into consideration previous history of surgery or radiotherapy. Nonirradiated fields and small defects may benefit from fistula excision and tracheal and esophageal multilayer closure. In cases of previous radiotherapy, local flaps or free tissue transfer yield high successful TEP closure rates. Depending on the defect size, sternocleidomastoid muscle flap or fasciocutaneous free flaps are optimal alternatives.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Additionally, as the tract is not divided, there is a hypothetical lower risk of suture slippage and subsequent infection in the potential space between the pharynx and trachea. 35 46…”

Section: Discussionmentioning

confidence: 99%

“…9 Nonetheless, repeated mucosal resections are only possible for this method if there is enough tracheal mucosa present. 46…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis

et al. 2022

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Follow-up of a national web-based survey on the SARS-CoV-2 infectious state of otorhinolaryngologists in Germany

Herzog

Beule

Lüers

et al. 2021

HNO

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Purpose. The SARS-CoV-2 pandemic has affected the health and practice of otorhinolaryngologists (ORLs) for over 1 year. Followup data of a national survey with German ORLs were evaluated regarding differences between the two waves of the pandemic. Methods. As in the initial survey, German ORLs were addressed via e-mail through the German Society of ORL, Head and Neck Surgery and the German ENT Association. All ORLs afflicted with SARS-CoV-2 were invited to participate in a web-based survey. General data on infections and concomitant parameters were evaluated. Results. Since the start of the pandemic, 129 ORLs reported testing positive for SARS-CoV-2 in Germany. The ORLs infected during the first wave had a relative risk (RR) of 4.07 (95% CI: 3.20; 5.19) of contracting SARS-CoV-2. During the second wave, the RR decreased to 0.35 (95% CI: 0.28; 0.45). The availability of personal protective equipment (PPE) increased from the first to the second wave along with an increased perception of protection in the professional environment. The source of infection shifted from infections via medical staff during the first wave to patients and household exposure during the second wave. Regular medical practice was resumed by clinicians and general practitioners in the second wave. Nevertheless, a proportionally lower infection rate was observed compared with the German population as a whole. Conclusion.The data reflect a unique longterm survey of ORLs during the pandemic. Differences in the source of infection were seen between the first and second wave, confirming the need for appropriate PPE for medical professionals working in high-risk environments. Further strategies to reduce the risk of infection include consistent testing for SARS-CoV-2 in healthcare professionals, patients, and the general public as well as vaccination of high-risk medical groups.

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Surgical closure of enlarged tracheoesophageal fistula after laryngectomy: A systematic review of techniques

Lane,

Wright,

Linton

et al. 2024

American Journal of Otolaryngology

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Surgical Closure of Tracheoesophageal Puncture Without a Flap Interposition

Cited by 4 publications

References 5 publications

Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis

Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis

Follow-up of a national web-based survey on the SARS-CoV-2 infectious state of otorhinolaryngologists in Germany

Surgical closure of enlarged tracheoesophageal fistula after laryngectomy: A systematic review of techniques

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