Aim: To determine success in use of voice prosthesis, prosthesis lifetime and long-term complications after total laryngectomy with primary tracheoesophageal puncture and to describe our approach to periprosthetic leakage.Introduction: Voice restoration after total laryngectomy is usually performed by placing a silicone voice prosthesis in an artificially formed tracheoesophageal fistula. Methods:We performed a retrospective study on 187 laryngectomies with primary tracheoesophageal puncture in the 15-year period, treated in our hospital.Results: In the group of patients with more than 1 year follow up, 87.8% of patients had successful voice restoration. Average prosthesis lifetime was 8 months. Long-term complications developed in 17.5% of patients. Periprosthetic leakage was the most common. We were able to successfully resolve long-term complications in 19/24 patients and they continued to use their vocal prostheses. Conclusion:The primary placement of the voice prosthesis is successful and safe way to restore a voice after a total laryngectomy. Complications are commonly treatable in an outpatient clinic or with minor surgery.