Second Step of LTP: A New Technique for Stoma Closure

Abstract

Objective: To present our protocol and propose a new surgical technique for the closure of the tracheocutaneous fistula in patients admitted for laryngotracheal reconstruction.

Method: We present a modified surgical technique to close the tracheocutaneous fistula performed on patients around 6 months after laryngotracheoplasty and decannulation. The procedure involves the closure of the stoma of the tracheal anterior wall by placing the suture along the longitudinal axis and approaching the tracheal margins in craniocaudal direction.

Results: Eight closures were performed in accordance with this technique without complications in the short and long term. Max follow-up was 3 years with no evidence of tracheal stenosis, tracheomalacia, tracheal pouch, or caliber irregularities on the site of the previous stoma. Although the modified closure technique slightly reduces the length of the trachea, it has proven to effectively enlarge the transverse diameter, reduce the risk of an extraluminal or intraluminal invagination of the flaps, and prevent secondary tracheal stenosis or pouch.

Conclusion: Based on our protocol for decannulation after LTP, we recommend postponing fistula treatment until the grafts have been well established, the stomal scar has reduced spontaneously, and the traumatic effect of intubation has been minimized. Our method for surgical closure has shown to reduce problems associated with these fragile tracheae.