Puncture Procedures
There are two tracheo-esophageal puncture procedure types: Primary and secondary puncture. Initially, the procedure was described as a secondary procedure and later also as a primary procedure.
Primary tracheoesophageal puncture: This procedure is performed during the total laryngectomy surgery. After removal of the larynx and creation of the tracheostoma, the puncture is made through the back wall of the trachea into the front wall of the esophagus. The main advantages of a primary puncture are: 1) that a second surgery to create the puncture is avoided (including the related costs and risks) and: 2) that the patient will be able to speak within a few weeks after total laryngectomy.
There are cases where a primary procedure cannot be performed. For example, this procedure cannot be used when there is complete separation of the tracheoesophageal 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). In that case, a sufficient period of recovery and wound healing would be required. A secondary puncture could then be placed. Secondary tracheoesophageal puncture: This procedure refers to a puncture that is placed anytime after the total laryngectomy surgery. The decision to use a primary or secondary puncture can vary greatly. Secondary puncture can be performed when: 1) primary puncture was not possible, 2) for re-puncture after closure of a previous tracheoesophageal puncture, 3)because of physician or patient preference, and 4) in case failure of esophageal or electrolarynx speech if this was chosen as the initial speech option.
Read more about this topic: Tracheo-oesophageal Puncture
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