[Prosthetic voice restoration after laryngectomy: the management of fistula complications with anti-reflux medications].
BACKGROUND
Approximately 30% of all patients show periprosthetic leakage or severe fistula enlargement after laryngectomy and prosthetic voice restoration. In a prospective study, we investigated the role of aggressive anti-reflux therapy in fistula complications.


METHODS
A total of 48 patients were assigned to one of two groups. Group A consisted of 16 patients with recurrent periprosthetic leakage. Group B comprised 32 patients without periprosthetic leakage. The presence of reflux was objectively assessed using 24-h dual-probe pH monitoring. All patients with pathological reflux underwent proton pump inhibitor (PPI) therapy. After 6 months, patients were re-evaluated for fistula complications and objective reflux parameters.


RESULTS
The mean absolute number of reflux events was 202.8 (+/-44) before and 74.5 (+/-22.9) after PPI therapy (p=0.025). The reflux area index decreased from 419.5 (+/-112.5) before treatment to 105.8 (+/-54.7) after treatment (p=0.0005). The mean DeMeester score was 104.4 (+/-21.3) without PPIs and 43.5 (+/-9.3) after 6 months with PPIs (p=0.028). A risk analysis for patients with both periprosthetic leakage and pathological reflux (15 patients at the beginning of the study, four patients after therapy) showed that the relative risk of periprosthetic leakage decreased to 0.3 (p=0.0054) with PPI therapy.


CONCLUSIONS
Patients with recurrent periprosthetic leakage in the region of the fistula showed a significantly higher number of supra-oesophageal reflux episodes. Rigorous anti-reflux treatment can help manage or prevent leakage problems in a large proportion of patients.
Lorenz
K J
KJ
Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081 Ulm. kai.lorenz@extern.uni-ulm.de
Grieser
L
L
Ehrhart
T
T
Maier
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects*; D057045:Laryngopharyngeal Reflux / Q000209:etiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D013071:Speech, Alaryngeal / Q000295:instrumentation* / Q000379:methods; D014138:Tracheoesophageal Fistula / Q000209:etiology* / Q000517:prevention & control*; D014832:Voice Disorders / Q000209:etiology / Q000517:prevention & control / Q000601:surgery
D054328:Proton Pump Inhibitors