Secondary tracheoesophageal puncture under local anaesthesia

Abstract

Introduction. In the Netherlands, primary tracheoesophageal puncture and voice prosthesis insertion is the current method of choice in prosthetic voice rehabilitation after laryngectomy. Secondary, or delayed, puncture is only performed if contraindications for primary puncture apply. Also, in patients with recurrent fistula-related problems, temporary closure of the fistula and consequent secondary puncture may be indicated. Secondary puncture, a minor and quick procedure, is performed under general anaesthesia. To decrease unnecessary patient burdens such as hospital admission or general anaesthesia, we developed a secondary procedure to be performed under local anaesthesia in the outpatient department. The patients were laryngectomized and in whom primary puncture was contraindicated owing to the extent of surgery, and those with persistent fistula-related problems needing a fresh tracheoesophageal puncture. Methods. After application of local anaesthetic, an insufflated balloon (to prevent oesophageal damage) was placed in the oesophagus at the desired fistula site. The tracheoesophageal puncture, in which the balloon was punctured, was performed under endoscopic imaging and the prosthesis was consequently inserted with the aid of a guide wire. Results. Patients do not experience the procedure as cumbersome. The procedure is easily performed and forms a quick and painless insertion technique with good results. Conclusion. This is a quick, easy and painless method for secondary puncture to be used in the outpatient clinic under local anaesthesia.