A Voice Production and Esophageal Reconstruction Methods after Total Laryngoesophagectomy

Nobuhiko Tanigawa, Takumi Shimomatsuya, Kohji Takahashi, Yasuhiko Masuda, Yasuto Kitakado, Tetsuya Horiuchi, Yukio Chiba, Ryusuke Muraoka, Hitoshi Saito*

Second Department of Surgery, *Department of Otolaryngology, Fukui Medical University

Cancer of the hypopharynx or the cervical esophagus often invades the adjacent larynx, so it has to be concomitantly resected for better prognosis. Loss of phonation in the laryngectomized patients needs to be corrected. A new voice apparatus, the tracheogastric shunt, has been studied experimentally and clinically. For better qualified phonation by shunt speech the stomach tube needs to be as narrow. However the narrower the stomach tube, the less blood flow there is in the gastric wall. Hence, we studied the need for adding vascular anastomoses between the gastric and cervical vessels. Blood flow in the gastric wall in mongrel dogs, measured by a hydrogen gas clearance method, was as follows, intact stomach, 110±0 ml/min/l00 g; stomach tube 2 cm in width, 0.8±0.8; after venous anastomosis, 0.5±0.8; and after arterial anastomosis, 19.2±1.4. The results indicated that blood flow in the cervically elevated stomach tube was greatly impaired and was improved by adding arterial anastomoses, but not by venous anastomoses. In 5 patients with pharyngo-esophageal cnacer, the anastomoses between splenic and superior thyroideal vessels were used in this type of esophagus surgery. The anastomoses were possible without a microscopic apparatus. An anastomotic leak was found in the tracheogastric shunt in one case, but no other complications relevant to surgery was noted. Phonation by shunt sppeech as satisfactory in one of two cases to whom the shunt was made.

Key words
total laryngectomy, cancer of the cervical esophagus, vocal rehabilitation, vascular anastomoses, gastric mucosal blood flow

Reprint requests
Nobuhiko Tanigawa Second Department of Surgery, Fukui Medical University, School of Medicine
23 Matsuoka-cho, Yosida-gun, Fukui, 910-11 JAPAN

Accepted
March 7, 1990

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