Are more sites placing a tracheoesophageal prosthesis at the time of primary puncture versus afterward?
There is a growing trend of placing the prosthesis at the time of the surgery. There are many advantages to that. There is significant research looking at the fact that patients have a nice stable party wall that do not change size. Of the 310 patients in the study who were followed over a significant amount of time, 64% of those patients never changed sizes. I do not think you see that very often when the red rubber catheter is placed. I have some theories about that. One thought is that there is irritation from the red rubber catheter and a shearing force on the puncture site. The other is that in all likelihood it is probably opening up the gastroesophageal juncture causing more acid reflux to occur mechanically, and maybe irritating the tract. I also see that from a cost perspective, typically when you see a red rubber catheter placed initially, you place about an 18 mm for that first prosthesis, then four days later they are at a 12, and then four days later, they are at a 10. You have thrown out 8 to 10 prostheses in the first two months or so of their rehab. From a cost perspective, research is showing that the first prosthesis, when placed in the OR, lasts 4 to 5 months. For example, I was at a county hospital last week and there is a man who was the first patient that we ever placed a prosthesis, and it is still working. That is about two years later and it is still functioning. So, I do see more of that trend.
Julie Bishop-Leone’s career as a Speech Language Pathologist spans 20 years first at the University of Michigan, Ann Arbor then as Clinical Manager of Speech Pathology and Audiology at the University of Texas, M.D. Anderson Cancer Center in Houston, TX. Specializing in alaryngeal voice restoration and swallowing she has participated in numerous clinical trials and co-authored several peer-reviewed papers focused on the head and neck oncology patient.