Effectiveness of laryngotracheal separation in neurologically impaired pediatric patients

Hara, Hirotaka; Hori, Tomohide; Sugahara, Kazuma; Ikeda, Takuo; Kajimoto, Madoka; Yamashita, Hiroshi

doi:10.3109/00016489.2014.885119

Cited by 19 publications

(13 citation statements)

References 12 publications

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“…All parents/caregivers agreed that LTS led to general flexibilization of care for these patients, primarily because there were smaller pulmonary complications. Hara et al, ( 3 ) assessed 21 patients submitted to LTS who presented with a significant reduction in episodes of pneumonia (3.38 versus 0.52; p<0.01) and in need of aspiration (4.0 versus 0.84; p<0.01), in which 17 patients had no episodes of pneumonia up to 6 months after surgery. ( 1 , 2 , 6 )…”

Section: Discussionmentioning

confidence: 99%

“…Our study reported a low rate of fistulas (5.4%), and all were treated by conservative approach. ( 1 − 3 , 6 , 8 − 13 )…”

Section: Discussionmentioning

confidence: 99%

“…Considering all these requirements, the technique preferred by many physicians and used in children, is the laryngotracheal separation (LTS), first described by Lindeman, in 1975, and modified in 1976. ( 3 – 5 )…”

Section: Introductionmentioning

confidence: 99%

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Laryngotracheal separation in pediatric patients: 13-year experience in a reference service

Antunes¹,

Talini²,

Carvalho³

et al. 2019

Einstein (São Paulo)

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Objective: To evaluate clinical stability of neurologically impaired children and adolescents with recurrent pneumonia submitted to laryngotracheal separation. Methods: Between October 2002 and June 2015, 92 neurologically impaired children from a reference service, with median age of 68.5 months were submitted to laryngotracheal separation. Data were evaluated and statistical analysis was made by Student's t test and Pearson's χ 2 test (significance level adopted of 95%). Results: Fifty-three children were male (57.6%). Forty-six children required admission to intensive care, and 42.4% needed mechanical ventilation. We observed that 90.2% of patients were exclusively fed by gastrostomy and 72.4% of the gastrostomies were performed before the tracheal surgery. Thirteen (14.1%) children had postoperative complications as follows: fistulae (5.4%), bleeding (4.3%), granuloma (2.2%) and stenosis (3.2%). A total of 24 patients had pneumonia in the postoperative period (26.1%), but there was a significant drop in occurrence of this condition after surgery (100% versus 26.1%; p<0.001). Twenty-three patients (25%) died. Postoperative complications were similar when comparing patients who died and those that presented good outcome (16.7% versus 13.2%; p=0.73). Conclusion: When well-indicated, the laryngotracheal separation reduces the incidence of postoperative pulmonary infections, thus improving quality of life and reducing admissions to hospital. Laryngotracheal separation should be indicated as a primary procedure in patients with cerebral palsy and recurrent aspiration pneumonia.

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Section: Discussionmentioning

confidence: 99%

“…Our study reported a low rate of fistulas (5.4%), and all were treated by conservative approach. ( 1 − 3 , 6 , 8 − 13 )…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Laryngotracheal separation in pediatric patients: 13-year experience in a reference service

Antunes¹,

Talini²,

Carvalho³

et al. 2019

Einstein (São Paulo)

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“…Sie ist für jeden Chirurgen eine ethisch schwere Entscheidung, da man chirurgisch normales laryngeales oder tracheales Gewebe alteriert und die Prozedur eine hohe Komplikationsrate von 58 % und Ineffizienz in 27 % hat [261]. Hara et al [262] gaben dementsprechend eine erfolgrei che laryngotracheale Separation bei zwei Drittel ihrer neurolo gisch beeinträchtigten Kinder an. Die laryngotracheale Separa tion kann rückgängig gemacht werden.…”

Section: Laryngo-tracheale Separationunclassified

Positionspapier der DGHNO und der DGPP – Stand der klinischen und endoskopischen Diagnostik, Evaluation und Therapie von Schluckstörungen bei Kindern und Erwachsenen

Arens

Herrmann²,

Rohrbach

et al. 2015

Laryngorhinootologie

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Zusammenfassung Schluckst?rungen sind h?ufig. Sie k?nnen zu erh?hter Mortalit?t durch aspirationsbedingte Lungenkomplikationen und Mangelern?hrung einerseits sowie einer erheblichen Beeintr?chtigung der Lebensqualit?t andererseits f?hren. Die demografische Entwicklung in Deutschland l?sst einen kontinuierlichen Anstieg der Dysphagie in den kommenden Jahren erwarten. Schwerpunkte sind dabei neurodegenerative Erkrankungen, die Tumoren im Verlauf der Schluckstra?e und die Folgen der Tumorbehandlung im oberen Aerodigestivtrakt. Vorrangig sind die ?rzte aus dem HNO-Bereich und der Phoniatrie als kompetente Fachgruppen zentrale Ansprechpartner f?r die Diagnostik und Therapieplanung der Dysphagie. Die meist komplexen St?rungen verlangen eine differenzierte Anamnese, Diagnostik und eine symptomorientierte Behandlung. Das Einbeziehen auch von nicht-?rztlichen Fachgruppen wie Logop?den, Physiotherapeuten und Ergotherapeuten in die Planung einer effizienten Therapie erweitert und komplettiert die kompetente patientenzentrierte Betreuung. Die konservative Dysphagietherapie durch Logop?den und ?hnliche Fachgruppen ist, auch l?ngerfristig, ein wichtiges Standbein der Behandlung. Zudem k?nnen Anteile der spezifischen Diagnostik in enger Kooperation ?bernommen werden. Eine interdisziplin?re Zusammenarbeit insbesondere mit den intensivmedizinischen neurologischen und internistischen Fachgruppen ist erforderlich. Die in diesem Positionspapier beschriebenen Verfahren der speziellen Endoskopie geh?ren zu den origin?ren ?rztlichen Leistungen, vornehmlich der Fach?rzte f?r Hals-, Nasen-, und Ohrenheilkunde bzw. f?r Sprach-, Stimm- und kindliche H?rst?rungen (Phoniatrie und P?daudiologie). Die Endoskopie ist eine ?rztliche Leistung, die grunds?tzlich nicht delegierbar ist ?In keinem Fall delegierbar sind Leistungen der Endoskopie (au?er Kapselendoskopien, die durch speziell ausgebildete nicht?rztliche Mitarbeiter gef?hrt werden k?nnen) und der Sonografie? siehe 278. Entsprechend ist eine Substitution des Arztes ausgeschlossen.

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“…Ethically, it is a very difficult decision for every surgeon because normal laryngeal or tracheal tissue is surgically altered and the procedure has a high complication rate of 58% and an inefficiency of 27% [ 258 ]. Correspondingly, Hara et al [ 259 ] reported on successful laryngo-tracheal separation in two thirds of their neurologically impaired pediatric patients. Laryngo-tracheal separation is a reversible procedure.…”

Section: Therapeutic Consequencesmentioning

confidence: 99%

Position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology – Current state of clinical and endoscopic diagnostics, evaluation, and therapy of swallowing disorders in children

Arens

Herrmann

Rohrbach

et al. 2015

GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery; 14:Doc02

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Effectiveness of laryngotracheal separation in neurologically impaired pediatric patients

Cited by 19 publications

References 12 publications

Laryngotracheal separation in pediatric patients: 13-year experience in a reference service

Laryngotracheal separation in pediatric patients: 13-year experience in a reference service

Positionspapier der DGHNO und der DGPP – Stand der klinischen und endoskopischen Diagnostik, Evaluation und Therapie von Schluckstörungen bei Kindern und Erwachsenen

Position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology – Current state of clinical and endoscopic diagnostics, evaluation, and therapy of swallowing disorders in children

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