Reflux Surgery for Improved TEP Outcomes after Laryngectomy

Abstract

Objective: 1) Identify the potential benefits of adequate reflux intervention in the management of TEP complications in the laryngectomized population. 2) Understand the role of PPI utilization for TEP complications. 3) Identify surgical intervention for reflux as a hierarchical treatment option for TEP complications not responsive to PPI utilization. Method: A retrospective chart review of laryngectomy patients in an otolaryngology private practice identified 4 patients from November 2009 to November 2011 who underwent fundoplication for TEP complications not responsive to PPI utilization. Prosthetic device life (days) as well as the presence of periprosthetic leakage was compared in preoperative and postoperative groups. Results: The 4 patients who underwent fundoplication for reflux management were referred for surgical intervention after persistent TEP complications following greater than 6 months of PPI utilization. Evidence of reflux was determined using transnasal esophagoscopy, barium swallow, and/or 24-hour pH monitor prior to surgery. Two of 4 were noted to have periprosthetic leakage prior to fundoplication which resolved following surgery. Both individual and group mean device life was noted to increase, with individual mean increases of 71.7%, 88.4%, 188.1%, and 41.3%, respectively. Group mean increase was noted at 85.9%, with significance demonstrated; P = .03. Conclusion: Although PPI treatment has been found to be an effective intervention for reducing TEP complications, some patients continue to demonstrate complications, despite months of PPI utilization. These findings suggest surgical intervention may be an effective means in this population of reducing associated complications and prolonged need for PPI utilization.