title: Stricture associated with primary tracheoesophageal puncture after pharyngolaryngectomy and free jejunal interposition.
abstract: BACKGROUND
  Free jejunal interposition has been one of the standard reconstructive options for patients undergoing total laryngopharyngoesophagectomy. Tracheoesophageal puncture (TEP) done primarily is a well-accepted means of voice restoration. The rapid recovery of swallowing and communication in patients who have advanced cancer of the upper aerodigestive tract is a valid goal. The objective of this study was to evaluate the functionality and complications of primary TEP in patients with a free jejunal interposition graft.
  
  
  METHODS
  Twenty-four consecutive patients who had free jejunal interposition were studied. Thirteen of these patients had a primary TEP. Stricture was assessed through barium swallow, laryngoscopy, and CT scan.
  
  
  RESULTS
  A statistically significant greater number of patients had stricture develop after primary TEP (p < .0325). All these patients had stricture develop at the distal anastomosis. These patients also tended to have a poorer quality of diet. Moreover, speech with a TEP prosthesis in patients with a free jejunal interposition was less intelligible and functional than speech with a TEP prosthesis after simple laryngectomy.
  
  
  CONCLUSIONS
  This article recognizes an increased incidence of stricture formation after primary TEP as compared with non-TEP in patients undergoing pharyngolaryngectomy with free jejunal interposition. The morbidity and possible etiology of this complication are discussed. This clinical data have been translated into a change in clinical practice.
authors.affiliation: McGill University Faculty of Medicine, Montreal, Quebec, Canada.
authors.forename: Gurston G
authors.initials: GG
authors.lastname: Nyquist
authors.forename: Michael P
authors.initials: MP
authors.lastname: Hier
authors.forename: Tassos
authors.initials: T
authors.lastname: Dionisopoulos
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Black
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D002404:Catheterization; D004032:Diet; D004940:Esophageal Stenosis / Q000209:etiology* / Q000628:therapy; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007583:Jejunum / Q000637:transplantation*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D010039:Otorhinolaryngologic Neoplasms / Q000601:surgery; D010611:Pharyngectomy; D011677:Punctures / Q000009:adverse effects*; D014132:Trachea / Q000601:surgery*