title: Clinical outcomes of tracheoesophageal diversion and laryngotracheal separation in neurologically impaired children.
abstract: OBJECTIVE
  Outcomes of tracheoesophageal diversion and laryngotracheal separation were evaluated in 15 neurologically impaired children treated for intractable aspiration.
  
  
  METHODS
  A retrospective analysis of the hospital records was carried out in 15 consecutive pediatric patients who underwent either tracheoesophageal diversion or laryngotracheal separation with trumpet-shaped tracheotomy from 1999 to 2006 in Kagawa Children's Hospital.
  
  
  RESULTS
  The number of hospital admissions for aspiration pneumonia after surgery was significantly decreased in 6 patients who were cared for at home. The parent-reported number of secretion suctioning was decreased after surgery especially in patients with pre-operative tracheotomy or intubation. Four patients fed through naso-gastric tube progressed with oral diet post-operatively, whereas 3 patients who had pre-operative tracheotomy developed temporary post-operative tracheocutaneous fistula that was managed by local wound care.
  
  
  CONCLUSIONS
  It is suggested that tracheoesophageal diversion and laryngotracheal separation decrease the morbidity of pediatric patients and improve their quality of life and that of their parents. It is suggested that the risk of developing post-operative fistula is higher in pediatric patients with than without pre-operative tracheotomy.
authors.affiliation: Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima 770-8503, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Chida
authors.forename: Koichi
authors.initials: K
authors.lastname: Tamura
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Nakagawa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ando
authors.forename: Emi
authors.initials: E
authors.lastname: Kuno
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hoshikawa
authors.forename: Nozomu
authors.initials: N
authors.lastname: Mori
authors.forename: Noriaki
authors.initials: N
authors.lastname: Takeda
mesh_terms: D000293:Adolescent; D020208:Brain Injury, Chronic / Q000150:complications; D002493:Central Nervous System Diseases / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D007830:Larynx / Q000601:surgery*; D008297:Male; D053120:Respiratory Aspiration / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D012189:Retrospective Studies; D055502:Secondary Prevention; D014132:Trachea / Q000601:surgery*; D014140:Tracheotomy; D016896:Treatment Outcome; D055815:Young Adult