Fantoni's translaryngeal tracheostomy: results and follow-up of 200 cases

Abstract

Introduction: Fantoni's translaryngeal tracheostomy (TLT) is the most recent alternative to surgical tracheostomy. Its originality consists of the retrograde tracheal dilatation achieved using a single device. This allows for: preservation of the integrity of the posterior tracheal wall, no traumatism of the peritracheal tissues, tight adherence of the stoma to the tracheostomic canula, irrelevant bleeding. A flexible fiberoptic bronchoscope (FFB) instead of a rigid tracheoscope (RCT) can be used in difficult intubation. This study was designed to analyse procedural, intermediate and late complications. Patients and methods: The TLT was performed, using the Mallinckrodt kit, on 200 patients aged 16–81 years: on 152 an RCT was used, on 48 the FFB was utilised. Results: There where no procedural complications. In 20 patients, we observed superficial infection of the stoma and in one patient significant purulence at the stoma side, 135 were decannulated and 5 were retracheostomized with the TLT technique during a second ICU stay. Fifty patients consented to the follow-up procedure at 3 and 6 months after decannulation. Follow-up has not evidenced either cosmetic or functional alterations. Conclusions: TLT is a simple and safe bedside technique, which can be used even in patients with coagulation disorders or neck deformities. The use of RCT is preferable, whenever possible, due to its inherent advantages.