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Tracheostomy Decannulation

Tracheostomy Decannulation

Tracheostomy decannulation is a significant milestone in the liberation of mechanically ventilated patients. Despite its importance, there is no universally accepted protocol for this procedure. This demands an evidence-based, individualized approach.
Description of the Procedure
Decannulation refers to the permanent removal of the tracheostomy tube, signaling the resolution of the condition that initially necessitated the tracheostomy. The process requires a well-coordinated interplay between...

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An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function

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Stapler Esophageal Closure During Total Laryngectomy.

Onur Ismi¹, Murat Unal, Yusuf Vayisoglu

¹*Department of Otorhinolaryngology, Faculty of Medicine †Department of Business Information Management, Silifke School of Applied Technology and Management, University of Mersin, Mersin, Turkey.

The Journal of Craniofacial Surgery

|November 29, 2016

Summary

Mechanical esophageal staplers reduce total laryngectomy time, lowering pharyngocutaneous fistula and surgical site infection rates. However, stapler use did not significantly impact postoperative systemic complications in laryngeal cancer patients.

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Area of Science:

Otolaryngology
Surgical Oncology
Medical Devices

Background:

Pharyngocutaneous fistula (PCF) and surgical site infections (SSI) are common complications after total laryngectomy.
Mechanical esophageal closure using staplers is an alternative to manual closure, potentially reducing surgical time.

Purpose of the Study:

To compare the rates of PCF, SSI, and operation times between mechanical stapler and manual esophageal closure during total laryngectomy.
To evaluate the impact of decreased surgical time on postoperative cardiovascular and cerebrovascular complications.

Main Methods:

A comparative study involving 30 patients undergoing mechanical stapler esophageal closure and 40 patients undergoing manual esophageal closure during total laryngectomy for laryngeal cancer.
Recording and comparison of PCF rates, SSI rates, operation times, and National Nosocomial Infections Surveillance (NNIS) scores between the two groups.

Main Results:

Total laryngectomy and total operation times were significantly lower in the stapler group (P < 0.001 and P = 0.024, respectively).
The stapler group demonstrated significantly lower rates of PCF (P = 0.032), SSI (P = 0.019), and NNIS scores (P = 0.009).
No statistically significant difference was observed in postoperative systemic complications between the groups (P = 0.451).

Conclusions:

Mechanical stapler esophageal closure is associated with decreased operation time, PCF, SSI rates, and NNIS scores.
Stapler use does not significantly reduce postoperative systemic complication rates.
While comorbid illnesses are risk factors for systemic complications, surgeons should not solely rely on stapler use to mitigate these risks.