Backgroud: Reconstruction of the larynx after total laryngeal resection has classically been treated with prosthetic devices either placed surgically or used as external devices. Surgical reconstruction of the voice tube has not been common due to complexity of the surgery as well as the inadequacy of the results. In this study the results of our experience with 9 patients that underwent simultaneous reconstruction of the trachea and esophagus using a segment of ileo-colon were evaluated. Details of the procedures as well as technical refinements and preliminary results are presented.

Materials and Methods: 9 patients between September 2001 and April 2002 underwent simultaneous reconstruction of a segment of upper esophagus as well as the voice tube using a segment of ileo-colon. Evaluation of outcomes of voice was performed using a 3 point scale. A score of 3 was given to a patient that was deemed to have a good result indicating speech that is intelligible. A score of 2 was given to a patient that had non-intelligible speech and 1 for a patient that had no speech either due to the lack of a connection with the trachea at this time or due a problem with the reconstructed voice tube.

Results: An average of 2 procedures were performed per patient to complete the reconstruction. Complications included: one patient with leakage of the upper cervical anastomosis, one donor site complication, and one patient with recurrence of his tumor. No patient has received a score of 3 at this point, seven patients received a score of 2 and two patients received a score of 1. Both of the patients that have received a score of one have not completed the final stage of voice tube reconstruction (connection of ileum with trachea). Results of those will be evaluated within the month of May.

Conclusion: The impact of achieving a successful reconstruction of the voice tube is great with the rewards potentially being very satisfying. External as well as surgically placed devices have achieved adequate intelligible speech, however, the patients are usually unsatisfied by the quality of the voice and the impracticality of the use of the device. Technical refinements as well as outcome of speech of this relatively new technique of using a segment of ileo-colon, with or without the appendix for total reconstruction of the voice tube are outlined the results in speech are demonstrated.