title: Laryngotracheal separation for intractable aspiration pneumonia in neurologically impaired children: experience with 11 cases.
abstract: OBJECTIVE
  Laryngotracheal separation (LTS) with or without end-to-side laryngoesophagostomy was performed as an antiaspiration procedure for intractable aspiration pneumonia in 11 children. The effectiveness of LTS for preventing aspiration was investigated.
  
  
  METHODS
  Eleven children aged from 9 months to 16 years with intractable aspiration pneumonia underwent LTS with (n = 8) or without (n = 3) laryngoesophagostomy at our institution over the last 2 years. Of these 11 patients, 7 underwent fundoplication with or without gastrostomy for gastroesophageal reflux (GER) before LTS (n = 5) or concurrently with LTS (n = 2). The effectiveness of LTS was evaluated by chart review and follow-up phone questionnaires.
  
  
  RESULTS
  LTS decreased the frequency of performing suction from an average of once every 30 minutes to once every 4.5 hours in all patients. In 5 patients who underwent fundoplication with gastrostomy before LTS, aspiration pneumonia remained unless they underwent LTS. Two patients who underwent LTS with or without laryngoesophagostomy tolerated oral feeding postoperatively. All parents rated LTS as excellent or good in terms of improving the quality of life.
  
  
  CONCLUSIONS
  LTS can be recommended for neurologically impaired children with intractable aspiration as a primary surgical intervention. If patients show impaired swallowing and GER, LTS could be performed simultaneously with fundoplication and gastrostomy.
authors.affiliation: Department of Surgery, Kobe Children's Hospital, Kobe, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Takamizawa
authors.forename: Chikara
authors.initials: C
authors.lastname: Tsugawa
authors.forename: Eiji
authors.initials: E
authors.lastname: Nishijima
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Muraji
authors.forename: Shiiki
authors.initials: S
authors.lastname: Satoh
mesh_terms: D000293:Adolescent; D002493:Central Nervous System Diseases / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000209:etiology; D004947:Esophagus / Q000601:surgery*; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000601:surgery; D006801:Humans; D007223:Infant; D007830:Larynx / Q000601:surgery*; D011015:Pneumonia, Aspiration / Q000209:etiology* / Q000601:surgery*; D011795:Surveys and Questionnaires; D014132:Trachea / Q000601:surgery*; D014139:Tracheostomy / Q000379:methods