LARYNGECTOMY FAQ'S

Why did my friend have his TEP done at the same time as his surgery? I had my puncture done months later.
(by Glenn E. Peters M.D., Director, Division of Otolaryngology
Head and Neck Surgery, University of Alabama at Birmingham,
Birmingham, Alabama, USA)

Let's discuss the timing of TracheoEsophageal Punctures. There are two opinions as to the proper time to do the procedure. There are surgeons who think that the TEP should be done as part of the laryngectomy (a primary TEP) and then there are those, myself included, who think it is best done as a separate procedure (a secondary TEP). Each camp has a long list of reasons why their approach is better and I will review those with you now.

The main advantage of the primary TEP is obvious: patients will be using their prostheses sooner during their convalescence. This saves a second operation and a second anesthetic. It also has the advantage that the feeding tube can be put into the esophagus through the puncture instead of through the nose, making the patient more comfortable. The main disadvantage has to do with wound healing and maturation of the stoma. The site of the puncture might shift relative to its position in the stoma, making placement of the prosthesis difficult.

Now, for the secondary TEP: I prefer to allow about eight weeks to pass between the time of the laryngectomy and the TEP. The main reason is I want to see how the wounds heal and, particularly, how well the stoma matures. It helps me to see if the stoma is going to shrink in size, called stenosis, and whether a stoma vent will be necessary. The patient needs to be swallowing well, especially foods like meat, as this indicates that the throat is the proper size. In addition, this allows some time for the initial pain and swelling from the laryngectomy to subside. I feel that I can do a better job and have more control of the positioning of the puncture inside the stoma after the stoma has fully healed. The down side, of course, is the need to have a second operation and the need to use a Servox for several weeks or months longer after the laryngectomy.

The bottom line is there are no differences in the speech results in comparing the large series of patients who had either the primary or the secondary TEP.