Primary versus secondary tracheoesophageal puncture: systematic review and meta-analysis

• Published in: Journal of laryngology and otology Vol. 132; no. 1; pp. 14 - 21
• Main Authors: Chakravarty, P D, McMurran, A E L, Banigo, A, Shakeel, M, Ah-See, K W
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.01.2018
• Subjects: Esophagus; Fistula; Fistulae; Meta-analysis; Ostomy; Otolaryngology; Patients; Prostheses; Rehabilitation; Review Articles; Statistical analysis; Studies; Success; Systematic review; Laryngectomy; Voice Prosthesis; Esophageal Speech
• ISSN: 0022-2151; 1748-5460
• DOI: 10.1017/S0022215117002390

Tracheoesophageal puncture represents the 'gold standard' for voice restoration following laryngectomy. Tracheoesophageal puncture can be undertaken primarily during laryngectomy or in a separate secondary procedure. There is no current consensus on which approach is superior. The current evidence comparing primary and secondary tracheoesophageal puncture was assessed. A systematic review and meta-analysis of articles comparing outcomes for primary and secondary tracheoesophageal puncture after laryngectomy were conducted. Outcome measures were: voice success, overall complication rate and pharyngocutaneous fistula rate. Eleven case series met the inclusion criteria, two prospective and nine retrospective. Meta-analysis did not demonstrate statistically significant differences in overall complication rate or voice outcomes, though it suggested a significantly increased risk of pharyngocutaneous fistula in primary compared to secondary tracheoesophageal puncture. Primary tracheoesophageal puncture is a safe and efficient approach for voice rehabilitation. However, secondary tracheoesophageal puncture should be preferred where there is a higher risk of pharyngocutaneous fistula.