title: Surgical management of gastroesophageal reflux and outcome after laryngectomy in patients using tracheoesophageal speech.
abstract: BACKGROUND
  Gastroesophageal reflux disease (GERD) is common in patients with head and neck carcinoma. The impact of laparoscopic fundoplication on laryngectomy patients with tracheoesophageal prostheses for voice restoration is unknown.
  
  
  METHODS
  Nine laryngectomy patients who use tracheoesophageal speech underwent laparoscopic fundoplication for documented reflux. Preoperative and postoperative symptoms were recorded. Quality of speech was documented before and after fundoplication.
  
  
  RESULTS
  Although 88% of patients had resolution of GERD symptoms, all developed bloating and hyperflatulence. There was no difference in quality of esophageal speech after laparoscopic fundoplication.
  
  
  CONCLUSIONS
  Fundoplication in laryngectomy patients that use tracheoesophageal speech eliminates symptoms of gastroesophageal reflux and resolves regurgitation associated prosthesis erosion. Although nearly all patients are satisfied with outcome, there is a high incidence of postfundoplication bloating and hyperflatulence that may be life limiting. Poor quality tracheoesophageal speech should not be used as an indication for antireflux surgery.
authors.affiliation: Department of Surgery, Oregon Health Sciences University, Portland, OR, USA. Blair.Jobe@med.va.gov
authors.forename: Blair A
authors.initials: BA
authors.lastname: Jobe
authors.forename: Eben
authors.initials: E
authors.lastname: Rosenthal
authors.forename: Tracy T
authors.initials: TT
authors.lastname: Wiesberg
authors.forename: James I
authors.initials: JI
authors.lastname: Cohen
authors.forename: John S
authors.initials: JS
authors.lastname: Domreis
authors.forename: Clifford W
authors.initials: CW
authors.lastname: Deveney
authors.forename: Brett
authors.initials: B
authors.lastname: Sheppard
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000601:surgery*; D005260:Female; D005414:Flatulence / Q000209:etiology; D018662:Fundoplication / Q000009:adverse effects; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006801:Humans; D007422:Intestines / Q000503:physiopathology; D010535:Laparoscopy / Q000009:adverse effects; D007825:Laryngectomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010039:Otorhinolaryngologic Neoplasms / Q000150:complications / Q000601:surgery*; D017060:Patient Satisfaction; D011788:Quality of Life; D012189:Retrospective Studies; D013072:Speech, Esophageal; D016896:Treatment Outcome