:Laryngotracheal separation for aspiration pneumonia remaining after fundoplication

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Aspiration pneumonia due to oropharyngeal dysphagia as well as gastroesophageal reflux (GER) is a vexing clinical problem in neurologically impaired children. Aspiration pneumonia may occur after successful fundoplication because of remaining difficulties of swallowing. We performed laryngotracheal separation (LTS) with/without end-to-side tracheoesophageal anastomosis as an anti-aspiration procedure for intractable aspiration pneumonia in five patients. All patients aged from 2.2 to 16.3 years had previously undergone fundoplication and gastrostomy. The neurological deficits causing aspiration include cerebral palsy after near drawing or hydrocephalus due to intracranial hemorrhage in 2 patients, Dandy-Walker syndrome in 1, lissencephaly in 1 and Leigh's syndrome in 1. None of these patients could speak. Only 2 patients could drink a small amount of liquid by mouth, although oral feeding was not achieved in the remaining 3 patients because of aspiration. Interval from fundoplication to LTS was ranged from 2 months to 2.7 years. LTS decreased frequency of suction from once every 30 minutes to once every 4.5 hours in average. Pneumonia was completely disappeared in 4 patients. All parents rated LTS excellent or good. LTS can prevent the neurologically impaired children from aspiration and provide higher quality of life.