This involves creation of a fistula between the trachea and the esophagus, puncturing the short segment of tissue or “common wall” that typically separates these two structures.
For example, this procedure cannot be used when there is complete separation of the tracheo-esophageal wall where the puncture would otherwise be placed (for example, in case a portion of the esophagus is removed requiring an anastomosis, or “reconnection” of structures in the region).
[citation needed] This procedure refers to a puncture that is placed anytime after the total laryngectomy surgery.
This tube is removed when the patient is able to eat enough by mouth to maintain nutritional needs; this can be as early as the second day following surgery.
The advantages of this method are: 1) the voice prosthesis stabilizes the TE wall, 2) the flanges of the device protect the puncture against leakage of fluids, stomach acids and other stomach contents, 3) there is no irritation or pressure from a stenting catheter, used to maintain the puncture opening until a voice prosthesis can be placed, 4) patients become quickly familiar with their prosthesis care as they receive instructions while hospitalized, 5) the patient will not have to undergo an outpatient procedure during which the voice prosthesis needs to be fitted, 6) many patients can learn to speak before the start of any post-operative radiation therapy (if indicated) 7) the patient can focus on voice production immediately, as wound healing allows.
[11] Another advantage is that generally, the voice prosthesis placed at the time of surgery lasts relatively long and requires no early frequent replacements.
The voice prosthesis is placed after the patient is able to eat sufficiently by mouth and speech production is initiated when healing has completed, after clearance by the surgeon.
Another disadvantage can be the need for more frequent replacements early after fitting of the voice prosthesis due to changes in the length of the puncture.
Patients must be able to understand and manage proper prosthesis maintenance and monitor for complications or device problems.