Tissue augmentation treatment for periprosthetic leakage in patients who have undergone a total laryngectomy: A systematic review

ObjectivesTracheoesophageal puncture (TEP) is considered the gold standard for voice rehabilitation after total laryngectomy. One of the main causes of treatment failure, and a potentially serious complication, is the TEP enlargement and/or leakage around the voice prosthesis. The injection of biocompatible material to increase the volume of the puncture surrounding tissue has been studied as a popular option for conservative treatment of enlarged tracheoesophageal fistula. The aim of this paper was to perform a systematic review of the efficacy and safety of such treatment. DesingnSearch conducted in PubMed/MEDLINE, the Cochrane Library, Google Scholar, Scielo and Web of Science and through the meta-searcher Trip Database based on Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) statement. SettingsHuman experiments published in peer-reviewed journals, where investigators assessed the use of peri-fistular tissue augmentation for periprosthetic leakage were evaluated. ParticipantsLaryngectomized patients with voice prosthesis, presenting periprosthetik leak due to enlarged fistula. Main outcomes measuresmean-duration without new leak. ResultsA total of 196 peri-fistular tissue augmentation procedures in 97 patients were found in the 15 selected articles. The 58.8% of patients had a time without periprosthetic leak after treatment of >6 months. The 88.7% of tissue augmentation treatments resulted in periprosthetic leakage cessation. The general level of evidence of the studies included in this review was low. ConclusionsTissue augmentation treatment is a minimally invasive, biocompatible and safe solution that temporarily resolves periprosthetic leaks in many cases. There is no standard technique or material, and treatment needs to be individualised according to the experience of the practitioner and the characteristics of the patient. Future randomised studies are needed to confirm these results.

Automated summary

This paper provides a systematic review on the efficacy and safety of using biocompatible material injection to increase the volume of peri-fistular tissue as a conservative treatment for enlarged tracheoesophageal fistula. The results suggest that this approach can temporarily resolve periprosthetic leaks in most cases, but there is currently no standard technique or material, and treatment should be individualized based on the practitioner's experience and patient characteristics. Rating: 8/10.