Surgery for aspiration: Analysis of laryngotracheal separation in 23 children

Abstract

Objectives: The objective is to analyze the efficacy of laryngotraqueal separation (LTS) in eliminating aspiration in children with chronic encephalopathy and its repercussions over the control of pulmonary infections and the impact of quality of life. Methods: Twenty-three children with neurological impairment and diagnosis of chronic aspiration were submitted to laryngotracheal separation at the Associação de Assistência à Criança Deficiente, using modified Lindeman technique. Age, nutritional status, pulmonary impairment, and presence of tracheostomy and gastrostomy previous to the surgery were described. The results of aspiration control were assessed by comparing pre- and postoperative frequency of hospitalization, pulmonary infections, and respiratory tract secretion levels. Results: Twenty-three children with chronic encephalopathy aged 11 months to 14 years were submitted to laryngotracheal separation. Thirteen children (56.5%) were malnourished. Fourteen children (60.9%) were tracheostomized, and 19 (82.6%) had been submitted to gastrostomy and Nissen fundoplication. All children gained complete control of aspiration, with an incidence of 17.4% of tracheocutaneous fistula. The frequency of hospitalization, number of respiratory infections, and level of secretion were statistically reduced. Only 21.7% of the children were capable of having exclusive oral intake after surgery. Children who had tracheostomy and gastrostomy with Nissen fundoplication previous to laryngotracheal separation presented mild pulmonary complications. Conclusions: Laryngotracheal separation is an effective technique to be used in children with chronic encephalopathy, reaching aspiration control in 100% of the patients. The reduction in frequency of hospitalization, pulmonary infections, and level of secretion has impact on general health and quality of life.